Wiki coding recurrent vs primary wrist ganglion removal

[adw9111]

Does anyone have any helpful links or resources that explain when to bill recurrent (25112) vs. primary (25111) wrist ganglion removal? My provider always comes back to me stating that ALL ganglions are recurrent and wants to bill recurrent removal 25112 instead of primary 25111 on every patient, regardless of whether or not the patient has had prior treatment on the ganglion. I would like to have some definitive documentation to back up the correct way to bill/code for a ganglion cyst removal. Thanks!

 

[meghanhannus]

Hello adw9111,

I am sorry but I do not have/could not find any helpful links or documentation on the coding of primary/recurrent wrist ganglion cyst excision. When I would code for this procedure the first time the patient had surgical excision treatment for the ganglion cyst was when CPT 25111 would be billed. Since ganglion cysts may come back after treatment that is when the patient would have a recurrence of the ganglion cyst and I would code CPT 25112 for the excision of recurrent ganglion. If you look at the procedure description of CPT 25112 it mentions scar tissue may be removed and the joint or muscle tissue may be repaired.

CPT 25112- the physician removes a ganglion from the wrist in 25111 or a recurrent ganglion in 25112. An incision is made overlying the ganglion. The tissues are dissected around the ganglion, freeing it from surrounding tissue. (Scar tissue may be removed in 25112.) The physician may dissect deep within the wrist joint in order to excise all of the ganglion. The ganglion is removed. The joint or muscle tissue may be repaired in 25112. The physician irrigates the wound with antibiotic solution and closes the wound in layers.