dr. discrepancy

[heathermc]

Our dr. removed a solid inclusion cyst from the leg that was 3 cm and deep into the subq tissue. A collegue and myself say the codes to use are 11403 and 12032 for the layered closure. He believes there should be another code to use. Does anyone have any suggestions. We don't believe we could not use the 27327/27328 because path specifically says cyst and not lipoma. Please help.

[mbort]

You should be using the 27327/27328. These are the codes that accurately report the excision and the depth that the doctor had to obtain to get there. When I look at my cross coder through Encoder Pro, the lipoma diagnosis is there. ( I do not let a diagnosis from a pathology report determine my codes for me.)

Per the CPT guidelines (of course I can't quote them right now because I can't locate where it says this..but...) you should only code from the integumentary section for excision of lesions when there is NOT an applicable code in the musculoskeletal section of the CPT book.

hope this helps
Mary

[FTessaBartels]

Heather,
When I first read your post, I thought, as Mary did, that 27327 was most appropriate.

However, now that I read it again, I see that you are saying that the cyst was and "inclusion cyst" which is typically coded as 706.2. And that's probably why you are leaning toward 11403 w/ 12032 for the layered closure.

BUT ... if you look at the ICD9 index you'll see that under Cyst - Inclusion - there is another subtext "not of skin" which points you to the "neoplasm, by site, benign" category. Which eventually takes you to 229.8 for the Dx code.

So, I'd code it as 27327 (based on the excision and depth required) w/ Dx 229.8

F Tessa Bartels, CPC, CPC-E/M

[heathermc]

Thank you so much! We have always used the lesion code for cysts, but when it came to being in the subq I quess we never paid attention to that detail, but your explanation makes sense. I'd rather use that code than the lipoma, since this was definately a cyst. Although i used code 215.3, after looking under subq it sent me to connect. tissue, and there i chose leg, which is a payable dx in my general surgery coding companion book. Thanks again.