coding help zygomatic arch biopsy


Pottstown, PA
Best answers
For the below op report my physician coded 20205 and 21034 -52. The CPT 21034-52 denied as an invalid modifier. How would you bill for the biopsies of the soft tissue of the zygomatic arch. Would you use 20200?

Procedure: Op-Biopsy of the RT masseter muscle and the RT zygomatic arch.

Indications: The patient presents with a one month hx of enlarging RT facial mass.

Findings: At the time of surgery had a large infiltrating tumor involving the RT zygomatic arch and RT masseter muscle with marked trimus.

Operative Note: The patient was identified, placed on the table in supine position. After adequate local anesthesia using approximately 10cc of 2% Xylocaine 1:1000,000 epinephrine injected into the RT facial space, the patient was prepped and draped in the usual manner. At this point, a 4cm incision was made over the RT zygomatic arch. fluid was initially encountered. At this point, an infiltrating mass involving the RT masseter muscle was noted. Multiple biopsies of this masseter mass were taken, sent to pathology for frozen section consistent with squamous cell carcinoma. At the same time, there was noted to be bone involvement of the RT side of zygomatic arch. Biopsies of the soft tissues surrounding the RT zygomatic arch and bone were also taken at that particular time and sent for pathology for permanent section. At this point, the incision was irrigated, closed in layer with 3-0 chromic suture, followed by 3-0 subcuticular chromic suture, closure followed by Steri-Strips and dressing. Patient Retuned to recovery room in stable condition.

Thanks for your assistance.

Camille Waterhouse, CPC