Excision mass in office vs OR

Missy13

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I have been thought previously, (example) when an excision of RT shoulder mass comes back from pathology as lipoma to bill 23075, and if it's cyst or lesion to bill 11402. Now when I change the code from 11402 to 23075 (procedure done in office) MA's disagree stating that CPT codes 2XXXX like 23075 are only for OR procedures. That if done in the office 114XX CPT codes should be used. I am getting vey confused now on billing mass excisions for OV vs OR procedures. Can anyone please clarify if this is correct? We even had a scenario when I changed the code from 114XX to 2XXXX because it came back as lipoma, the insurance applied higher copay/deductible to patient and they all stated I coded it wrong. Please help me understand this. Am I wrong?
 

thomas7331

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Agreed, the code should be based only on the documentation of what was performed. I'd add that it's also not the diagnosis that would determine the CPT code.

There's an article in the September 2018 issue of CPT Assistant that clarifies the difference between these types of excisions, stating that "Musculoskeletal System subsection defines procedures related to the excision of subcutaneous soft connective tissue tumors, fascial or subfascial soft tissue tumors, radical resection of soft connective tissue tumors, and radical resection of bone tumors.... Use documentation of the depth of the lesion to determine whether codes from the Integumentary System or Musculoskeletal System are appropriate to report." So 23075 would be used to report an excision of a deep soft tissue tumor that does not involve the skin. Excision of a lipoma involving only the skin and subcutaneous tissue without involvement of the 'soft connective tissue' would be reported with the 114XX range of codes. The code assignment should be based on the physician's documentation of the work done, and not made based on the place of service or on the outcome of the pathology report.
 

dkissel

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I'd add that diagnosis matters if it a skin lesion when it is malignant. You would use 116XX instead of 114XX.
 
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