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Excision mass of forehead

  1. #1
    Default Excision mass of forehead
    Medical Coding Books
    After anesthesia was obtained, an incision was made through the skin down to the attenuated muscle. This was separated and beneath this a fatty mass was identified. The mass was dissected away from the underlying musculature and then the edges were approached.

    Does anyone have any ideas on CPT coding for this procedure?

  2. Default Excision mass forehead
    Plastic Surgery CPT Corner coding instruction says to use 21555, excision tumor soft tissue of the neck/thorax because there is no specific code for the deeper mass excisions of the face but since the surgery is comparable in time, effort and expertise they are appropriate codes and you can use the -52 modifier depending on the difficulty of the case.

  3. Default
    I'm sorry, I disagree, CPT 21555 is specifically for "neck/thorax", I would never use this for a "forehead" mass; my question is with regards to pathology as well as the type of closure??? was it malignant or benign and what type of closure was done; there are some options depending on your response.

    Need more info.

    ENT CT

  4. #4
    Default excision of mass of forehead
    Path came back as lipoma, microscopic exam reveals adipose tissue without plexiform blood vessels or significant nuclear atypism.

  5. #5
    Milwaukee WI
    Default Unlisted
    I wouldn't be comfortable using 21555 as this is not on the neck or thorax.

    I would code 21499 Unlisted Musculoskeletal procedure, head. I would base my pricing on 21555 or 21030.

    F Tessa Bartels, CPC, CEMC

  6. Default
    code 21013 sounds like what you are looking for.

  7. #7
    Athens, OH
    I disagree with the 21555 as well and also the unlisted procedure.

    I agree with jbnewlife77 if it was less than 2 cm it would be 21013 or if it is larger it would be 21014
    RBoggs CMA, CGSC **Bloom where you are planted**

  8. #8
    Quote Originally Posted by jbnewlife77 View Post
    code 21013 sounds like what you are looking for.
    The original post and replies were from 2009. Codes 21011-21014 were new codes in 2010's CPT and did not exist in 2009.

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