Wiki excision cysts or lipoma etc

[stogsmom3]

I code for general surgeons that do a lot of excisions of lipomas and sebaceous cysts. They never document the size of incision. They only give me size of cyst or Lipoma. It was my understanding that the incision size needs to be documented. And I would code off the size of incision not size of cyst or lipoma. My understanding is the cyst or lipoma incision could be smaller than the actual cyst or lipoma.

 

[thomas7331]

Code selection for excisions of benign lesions is determined by the size of the lesion plus margins, not by the length of the incision. You're correct that the incision can measure less than the lesion, but it's the lesion measurement that's used for coding. There are good instructions in CPT at the beginning of the excision section which will give you a pretty complete explanation of the rules for translating the lesion measurements to the correct codes.

 

[ellzeycoding]

I code for general surgeons that do a lot of excisions of lipomas and sebaceous cysts. They never document the size of incision. They only give me size of cyst or Lipoma. It was my understanding that the incision size needs to be documented. And I would code off the size of incision not size of cyst or lipoma. My understanding is the cyst or lipoma incision could be smaller than the actual cyst or lipoma.

Also, make sure you look at the often overlooked soft tissue excision codes which are coded by site, size as well as depth (subcutaneous, subfascial, etc.). These are usually appropriate for deeper cysts like lipomas.

For example...

Site: Trunk/Back

21930 Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm
21931 Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater
21932 Excision, tumor, soft tissue of back or flank, subfascial (e.g., intramuscular); less than 5 cm
21933 Excision, tumor, soft tissue of back or flank, subfascial (e.g., intramuscular); 5 cm or greater

 

[jacksoneg]

excision cysts and/or lipoma's

My understanding is it is the size of the lesion plus the margins it takes to remove it. So they would measure the lesion before excising, then add the margins it takes to remove it.
With a cyst the margins may be smaller but the size of the lesion plus the margins is the size you should use to bill the correct excision code. The CPT book gives you some examples on measuring benign and malignant lesions, if you would like a visual to show the doc's. They have a benign lesion that is 2.0cm, and the margins to remove it are 0.2 x 0.2cm so the excision size is 2.0 + 0.4cm = 2.4cm. In the cpt 2018 it is on page 79, at least in my AAPC cpt. Hope this helps, can be confusing. Good luck. There are soft tissue codes also which are under musculoskeletal section starting with 21920, by location and size also, that may be appropriate for the lipomas. Hope this helps!!

Lisa Jackson, CPC, CPCD
jacksoneg1122@gmail.com