General Surgery Coding Alert

Question: The surgeon excised two sebaceous cysts off of the patient's back. One cyst was 4.7 cm and the other was 3.3 cm. How should I code this?


Texas Subscriber
 

Answer: For the 4.7-cm cyst excision, you should assign 11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm). You should report 11404-59 (... excised diameter 3.1. to 4.0 cm; distinct procedural service) for your surgeon's removal of the 3.3-cm cyst.

Reporting 11406 and 11404 is correct for three reasons:

1. the lesions were benign

2. they were located on the patient's "trunk"

3. the cysts' measurements match the specified lesion diameters in the codes' descriptors.

You need to attach modifier -59 to 11404 to show the insurer that the second excision was separate and distinct from the first procedure.