General Surgery Coding Alert

Question: I've been told that lipoma removals are always coded from the musculoskeletal system portion of CPT (20000-series codes). Is this correct? Massachusetts Subscriber Answer: Few things in coding are absolute, and that applies in this instance as well. Lipomas are benign (noncancerous) tumors made up of fat cells, which commonly occur under the skin and are easily removed. Appropriate coding for lipoma removal depends on location. For example, if the lipoma is primarily a skin lesion, you should choose an appropriate code from the "Excision-Benign Lesions" (11400-11471) or "Repair-Complex" (13100-13160) portions of CPT, depending on the extent of the procedure.

If the surgeon removes a lipoma from the breast, choose from among the breast excision codes, 19000-19126 and specifically 19120 (Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion; nipple or areolar lesion [except 19140], open, male or female, one or more lesions). Alternatively, some experts recommend reporting a breast biopsy (for example, 19101, Biopsy of breast; open, incisional), reasoning that although malignancy is unlikely, it is possible. For lipomas below the fascia, however, you should use the musculoskeletal codes, such as 21930, Excision, tumor, soft tissue of back or flank. Check documentation carefully before assigning a code for lipoma removal, and do not assume that the musculoskeletal codes apply in every instance.