Wiki Excision epidermal inclusion cyst

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hsmith67

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Happy New Year! Need some help with an excision code debate:
A 2.5 skin incision was made. The incision extended all the way down to the subcutaneous tissue. The platysma muscle was identified and divided. Deep to the platysma muscle there was an epidermal like mass that appeared to be well encapsulated. With meticulous dissection by hugging the capsule, we were able to dissect the mass which was sent to pathology for further study.
Pathology diagnosis: Epidermal inclusion cyst.

Debate: do we code this based on the "origin" and since this was "epidermal inclusion cyst" use integumentary codes and therefore 1142x? Or, do we code this to the depth the surgeon had to go and code 21555?

Please provide any links/references you have.
Thanks so much,
Hunter Smith, CPC
 
Happy New Year! the 1142x due to the procedure is the excision and path stating epidermal cyst
now if path say came back with lipoma then that would be the latter category
 
I'm afraid I disagree with both responses here. The CPT should reflect the provider's work and not the final pathology of the lesion. Since this cyst was located below the muscle and required that the provider divide the platysma in order to access the lesion, it's clearly not an excision that is just limited to the skin and subcutaneous tissues, so I would code 21555. To assign the skin excision code would undervalue the provider's work and the complexity of the procedure here. Pathology has no bearing on the procedure code choice in this instance.
 
thomas7331 said:
I'm afraid I disagree with both responses here. The CPT should reflect the provider's work and not the final pathology of the lesion. Since this cyst was located below the muscle and required that the provider divide the platysma in order to access the lesion, it's clearly not an excision that is just limited to the skin and subcutaneous tissues, so I would code 21555. To assign the skin excision code would undervalue the provider's work and the complexity of the procedure here. Pathology has no bearing on the procedure code choice in this instance.
Click to expand...
I agree.
 
hsmith67 said:
Happy New Year! Need some help with an excision code debate:
A 2.5 skin incision was made. The incision extended all the way down to the subcutaneous tissue. The platysma muscle was identified and divided. Deep to the platysma muscle there was an epidermal like mass that appeared to be well encapsulated. With meticulous dissection by hugging the capsule, we were able to dissect the mass which was sent to pathology for further study.
Pathology diagnosis: Epidermal inclusion cyst.

Debate: do we code this based on the "origin" and since this was "epidermal inclusion cyst" use integumentary codes and therefore 1142x? Or, do we code this to the depth the surgeon had to go and code 21555?

Please provide any links/references you have.
Thanks so much,
Hunter Smith, CPC
Click to expand...
Happy New Year!

I actually just coded these myself yesterday, six in one encounter! My providers are pretty good at documentation, so even though he did go further than cutaneous/subcutaneous on a couple of them, he did indicate the closure of the wound defects as intermediate- so in addition to the 114XX codes, I also coded the intermediate closure 12036, this will help the provider’s work value in the case, shows how deep the cysts were- yours sound more complex, so hopefully your provider documented the closure of the defect and you can apply the repair/closure of the procedure. If not, you may ask them to addend their note to indicate the type of closure for such a depth.

Epidermal Inclusion Cysts are defined to the cutaneous regions so you’d use the integumentary system code (114xx). The codes in the musculoskeletal system (2xxxx) are for tumors that are non-cutaneous in origin. So even though the depth of the excisions can make the procedure more difficult, it doesn’t have bearing on the code selection. That’s another point to remember- both systems are based on the size of lesion- not how far down in the body it’s located. Most cases like these, I utilize the pathology to really define what is excised (cyst vs lipoma, etc) to help in the code selection.

Hope that brings a little clarification in coding EICs! 😊
 
Agree with both Lisa and Thomas. The reporting IS based on the physician work as CPT is BASED on physician work as defined by the AMA which composes the CPT codes themselves. Therefore, the reporting should be based on the difficulty.

The value of a given medical service is measured in relative value units (RVUs) which have three components: physician work RVU, practice expense RVU, and professional liability insurance RVU. The sum of these three components, each adjusted for geographical cost differences, is the total RVU for a specific CPT® code.
Source:
Marisa P Andrews-Warnes, BS, CPMA, CPC, COSC, CPC-I, CCS-P
 
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