Wiki coding for excision soft tissue tumor neck

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briannah

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My doc excised a subcutaneous soft tissue tumor on the mid trapezial neck, 4.5cm x 4.2cm, margins were .2. This was coded using CPT 21552, UHC stating that code is not valid in the office and upheld their decision after it was appealed. I can't find anything saying it's not allowed in an office setting or is there a better code to use? thank you in advance.
 
briannah said:
My doc excised a subcutaneous soft tissue tumor on the mid trapezial neck, 4.5cm x 4.2cm, margins were .2. This was coded using CPT 21552, UHC stating that code is not valid in the office and upheld their decision after it was appealed. I can't find anything saying it's not allowed in an office setting or is there a better code to use? thank you in advance.
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CPT 21552 is on UHC's site of service list. That list shows codes that are typically done in an ASC, but may be approved for outpatient hospital.


Medicare has an ASC payment indicator G2 assigned to CPT 25112, which means "
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Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight."
 
You'll likely want to look at the 11426 or 11626, depending on whether it was benign or malignant. Look at the "Code also" notes too, if the documentation supports a complex or intermediate closure, or a Modifier 22 for a complicated or unusual excision.

11426:


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11626:


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