Otolaryngology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Which code should we use when excising a submental mass?

South Carolina Subscriber

    Answer: Use any of the following codes, depending on where the mass was and how it was removed:

15838 Excision, excessive skin and subcutaneous tissue (including lipectomy); submental fat pad

21555 Excision tumor, soft tissue of neck or thorax; subcutaneous

21556 deep, subfascial, intramuscular

41007 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space

41016 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submental.
 

 Although 15838 refers specifically to an excision involving the submental space, this procedure is often considered cosmetic (i.e., it may be difficult to obtain payment even when the excision is medically necessary). Additionally, 15838 describes the excision of a fat pad (i.e., lipectomy) and not a mass.
 
Codes 21555 and 21556 also describe excisions but refer specifically to tumors and not the more generic term "mass." Furthermore, although the submental space is close to the neck, it is (anatomically speaking) a separate area and carriers may determine that these neck and thorax procedures do not apply.
 
Codes 41007 and 41016 describe incision and drainage (I&D) of a submental mass. The codes differ in that the mass is either drained from inside the mouth (41007) or drained externally (41016). In this case, the submental mass was excised and no I&D was performed. Although it is unlikely, some carriers may accept modifier -22 (Unusual procedural services) (if documented properly) and pay more for the excision.
 
Unlisted-procedure code 40899 (Unlisted procedure, vestibule of mouth) or 21899 (Unlisted procedure, neck or thorax) may be used. Any claim involving unlisted-procedure codes should be sent in manually with the operative report.
 
It is always a good idea to wait for the pathology report before determining the correct code; in this case, the lab results may provide more information to help in choosing the correct code. The selected code should be as close as possible to what is reported in the operative note and pathology report.
 
Whenever possible, ask carriers which of these coding scenarios they prefer.