Wiki Need help excision left vulva cyst and Right Incision drainage of vuvla

[tblmt1966]

I'm coming up with 11423, LT and 1160 RT

Procedure detail:
After consents were signed and IV fluids running, patient was taken to the operating room and placed in dorsal supine position. General anesthesia was obtained and found to be adequate. Patient was repositioned into a dorsal lithotomy, using candy cane stirrups. A time-out was performed by the circulating nurse prior to the procedure. Patient was prepped and draped vaginally and in normal sterile fashion.

The vulva was inspected and a 1 cm left vulvar cyst noted. 0.5% marcaine was injected and a 1.5 cm vertical incision made over the cyst. The cyst wall was carefully dissected off and the cyst was sent to pathology. A horizontal mattress suture was used to close the incision with a 3-0 vicryl. Good hemostasis achieved. There was a 2 mm cyst noted on the right vulva which was incised and drained and the capsule was removed using Adson's. Good hemostasis with pressure

Sponge lap and needle counts were correct for all counts. The patient tolerated the procedure well and was taken to recovery room in stable condition.

Complications: None; patient tolerated the procedure well.
Disposition: PACU - hemodynamically stable.
Condition: stable
Cancer Staging: no


pathology report
Received in formalin labeled with the patient's name, medical record number and "left vulvar cyst," is a 1.0 x 0.8 x 0.5 cm portion of tan-red soft tissue, which is bisected to reveal a hemorrhagic cut surface. No definitive cystic structure is grossly identified. The specimen is entirely submitted in cassette 1A.

 

[nielynco]

I'm coming up with 11423, LT and 1160 RT

Procedure detail:
After consents were signed and IV fluids running, patient was taken to the operating room and placed in dorsal supine position. General anesthesia was obtained and found to be adequate. Patient was repositioned into a dorsal lithotomy, using candy cane stirrups. A time-out was performed by the circulating nurse prior to the procedure. Patient was prepped and draped vaginally and in normal sterile fashion.

The vulva was inspected and a 1 cm left vulvar cyst noted. 0.5% marcaine was injected and a 1.5 cm vertical incision made over the cyst. The cyst wall was carefully dissected off and the cyst was sent to pathology. A horizontal mattress suture was used to close the incision with a 3-0 vicryl. Good hemostasis achieved. There was a 2 mm cyst noted on the right vulva which was incised and drained and the capsule was removed using Adson's. Good hemostasis with pressure

Sponge lap and needle counts were correct for all counts. The patient tolerated the procedure well and was taken to recovery room in stable condition.

Complications: None; patient tolerated the procedure well.
Disposition: PACU - hemodynamically stable.
Condition: stable
Cancer Staging: no


pathology report
Received in formalin labeled with the patient's name, medical record number and "left vulvar cyst," is a 1.0 x 0.8 x 0.5 cm portion of tan-red soft tissue, which is bisected to reveal a hemorrhagic cut surface. No definitive cystic structure is grossly identified. The specimen is entirely submitted in cassette 1A.

So 1160 is not a CPT code - did you mean 10060 (I&D of an abscess) for the right side? For the cyst on the left, it was removed in its entirely and given the dimensions in the path report and in the op note, you can only bill 11421 for this removal on this side. The other cyst was incised and drained but the documentation does not indicate it was an abscess therefore you may have a diagnosis/procedure code mismatch. There are no specific codes for an I&D of a vulvar cyst in the 5xxxx code section.

 

[tblmt1966]

So 1160 is not a CPT code - did you mean 10060 (I&D of an abscess) for the right side? For the cyst on the left, it was removed in its entirely and given the dimensions in the path report and in the op note, you can only bill 11421 for this removal on this side. The other cyst was incised and drained but the documentation does not indicate it was an abscess therefore you may have a diagnosis/procedure code mismatch. There are no specific codes for an I&D of a vulvar cyst in the 5xxxx code section.

Sorry, for late reply I've been out on a family emergency. Yes, I meant to say 10060 for the right. I agree that there is no specific code for the I&D of vulvar sys in the 5xxxx code section. When I looked at the 10060 Incision and drainage in the CPT book states Incision and drainage of abscess (eg carbuncle, suppuration hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia. simple or single. If this is incorrect code the right vulvar cyst, what code would you recommend? For the right operative report, the provider state 1 cm left vulvar cyst 1.5 cm vertical incision made over the cyst, however on the pathology report stated left cyst was 1.0 x 0.8 x 0.5 would not add the 1.0 + 0.8 + 0.5 = 2.3.

 

[csperoni]

1) I&D cyst. I would also suggest 10060. @nielynco was providing further advice that since this code description states I&D of abscess, some carriers may initially deny the claim as the diagnosis is not an abscess.
2) Excision of a benign lesion is coded for the diameter size of the excision, not the size of the lesion. The op report is the best reference to use. In that document, the physician states a 1.5cm excision. That is the size I would use, leading me to 11422.
Please note: lesion excisions are NOT measured by adding all dimensions. They are coded by the diameter measurement of the lesion plus margin on both sides. So for this specific case, the lesion size was 1cm with a margin of 0.25cm (so 1.0 plus 0.25 plus 0.25).
It's been awhile since I looked at a paper CPT book, but I'm pretty sure in the section there's even a diagram to help explain it. Some physicians word it very clearly, some you have to do the math. The way this physician worded it, no math is needed.
Here's an AAPC article from a few years back that may be helpful to explain the measurement. https://www.aapc.com/blog/49515-4-steps-for-improved-excision-coding/
FYI - not the case here, but always a good reminder that simple closure is included. If intermediate or complex repair, that is billable separately.