V codes can be used as first list codes for visits. Some V codes are first list only allowed, some are secondary only so you need to check for the proper placement of the code.
As far as the use of the V58.49 vs V58.78, If this was a followup encounter then use V67.09, for follow up after surgery. An aftercare encounter says that there is something being done for the patient such as suture removal or fitting and adjustment of a device. If you will see the note with the V58.7 codes that instructs you to use the code that specifies the reason for the after care. Whereas follow up is an encounter to just look the patient over to be sure they are doing OK.
Also you would not code the cyst any longer as your statement indicates the cyst was removed so it no longer exisits. Remember this is the patient's dx and we can code only the reason for the encounter and not for dx that do not exisit.
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