Otolaryngology Coding Alert

Mixing up branchial and preauricular cysts can put you in the wrong CPT section. Unless you grasp neck and ear anatomy, you could cut $336 in facial tissue transfer (14040) reimbursement by instead reporting branchial cleft cyst excision (42810). See if your vocab is up to par by examining the following operative report. Code This Excision Procedure: Excision of left preauricular first branchial cleft sinus tract in a previously operated field. Pre-/postoperative diagnosis(es): Recurrent left preauricular first branchial cleft sinus tract. Note: This procedure qualifies for modifier 22 because it is a revision surgery in a previously operated field. Specimens sent to lab: Overlying skin plus the deep sinus tract. Indications for surgery: Recurrent left preauricular sinus tract. Findings in surgery: Scarred preauricular areas from previous excision with no cutaneous fistula and no discernible sinus tract. Procedure: - An incision was made with the #11 scalpel blade around the area that the parents had stated most recently drained. This area was over the tragal cartilage region. A portion of the tragal cartilage was transected as the deep plane of the excision. Then, dissection was carried inferiorly and superiorly plus anteriorly to remove this portion of the pretragal scar and deep tissue. The depth of the dissection was the parotid gland. It was apparent that there was a large amount of scar tissue at the anterior excision site, and this was felt to also contain branchial cleft sinus tissue. Therefore, further excision of the scar was performed with the #11 and #15 scalpels, and a large portion of tissue removed down to and including a portion of the superficial aspect of the parotid gland. ... After removal of the specimen, a significant defect was present in the preauricular region. The closure of this area required undermining the facial skin inferior to the oracle and then anteriorly approximately one-third to 40 percent of the way to the corner of the mouth and lateral canthus of the eye. The tissue was then advanced and portion of the tissue rotated to allow a closure in a parotidectomy or fascial fashion in the preauricular area with a T-segment going anteriorly at the level of the tragus. Plicating 3-0 chromic sutures were used to reduce the space made vacant by excision of the deep tissue. This closure of the deep space was made possible by advancing the adipose tissue posteriorly and superiorly. Again, this tissue was held in place with 3-0 chromic suture. Check Cleft Type Identifying whether the cyst excision was in the neck or ear region avoids using a code from an incorrect CPT anatomy section. Make sure you don't lump branchial and preauricular cysts. "Each is from a different embryological source," explains John [...]