General Surgery Coding Alert

Question: Codes 21557 and 24077 describe radical excision for the neck and arm, respectively. Per CPT, the examples specify "malignant" neoplasm. Can these only be used in the case of malignancy? If so, what should be used in the case of benign tumors, and what needs to be dictated in the report to substantiate the coding?

North Carolina Subscriber

Answer: You should not use 21557 (Radical resection of tumor [e.g., malignant neoplasm], soft tissue of neck or thorax) and 24077 (Radical resection of tumor [e.g., malignant neoplasm], soft tissue of upper arm or elbow area) for benign tumors. The answer to what the proper coding should be is not the same for the two body areas.

For the neck and thorax, if the procedure is truly for soft tissue or muscle benign tumor, you would have to code the excision with code 21899 (Unlisted procedure, neck or thorax). Note that the neck and thorax don't have a lot of deep soft tissue so many of these services might actually be skin excisions. In that case, you would code the procedure as a skin excision using the proper code from the 114xx (Excision, benign lesion ...) series.

For the upper arm, you would use either code 24075 (Excision, tumor, soft tissue of upper arm or elbow area; subcutaneous) or 24076 (... deep [subfascial or intramuscular]). You can use these codes for either benign tumors (such as lipomas) or malignant tumors that do not require radical resection.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPCOBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) Compliance Program.