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10040 vs 114xx

  1. #1
    Default 10040 vs 114xx
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    Hi, one of my docs (internal medicine), performed removal of cyst on a patient and insurance denied so the patient has been calling to see if we can change the cpt. Here is the very brief procedure note:

    "Under sterile conditions and 2% xylocaine, I incised the cyst sharply. The sample was sent to pathology. I closed the skin with 3 sutures of 4-0 nylon. Neosporin was applied and some nonstick dressing was used."

    Path report states epidermal inclusion cyst.

    I used 10040 because in the cpt book, if you go to removal, cyst, it lists 10040. Or should this be an excision code 114xx ? Now he is saying it should have said excision not incision. The date of this goes all the way back to Jan of 2017.

    Thanks for any input!

  2. #2
    What kind of cyst was removed? Check the pathology before changing any codes.

    10040 is for acne surgery. If the cyst was acne then you selected the correct code.

    If it is not cystic acne then you choose from the 114XX series.
    Carol Gaston CPC CRC CPCO

  3. Default
    This sounds like I&D

    For incision (and drainage) of epidermal or sebaceous cysts consider 10060 series

    10060, incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single
    10061, incision and drainage of abscess; complicated or multiple

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