# buttock mass



## codedog

What cpt codes goes with excsions of buttock mass 
27618 ?
21930  ??
27047  ????

ASK people I WORK with all have diffrent answers , if I have to guess would  your hips 27047- be considered your buttock ?


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## magnolia1

can you provide details from the Procedure report?


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## codedog

Yes, 
 Diagnosis:  Posterior coccygeal upper buttock mass, clinically lipoma versus fibrous reaction from foreign body.
Operation:  Excision of mass, greater than 5cm.
After appropriate informed consent was signed, the patient was taken to the operating center and transferred to the operating table.  The patient was placed in the prone position after being intubated.  The area was prepped and draped in the normal fashion. The area had been identified and marked by me in the preoperative holding area.  The incision was made directly over the area in a horizontal then a vertical fashion around 7 to 8 cm.  Dissection was carried down through skin and subcutaneous tissue.  The mass was noted to lie laterally on this side of the coccyx, and it was dissected around all the way to the coccyx.  This was not a pilonidal.  There was some reactive tissue around it.  The entire mass was removed from the surrounding tissue from around 7 to 8 cm.  Excellent hemostasis was noted to be obtained.  This left a large defect, and the skin was closed over this.  There was no other deep tissues to close.

Pathology Report came back as 709.2 - scar tissue with fat necrosis.


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## magnolia1

what about 11406, with an additional diagnosis of 709.3?


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## codedog

Karen why did you choose integumentary code  , just curious


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## magnolia1

report doesn't mention going beyond subcu.........


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## codedog

ok, please if you dont mind , please help me out here 
 cpt code 27047 says subcutaneous while 27048 says subcutaneous but subfascial , i always thougt if it is subcutaneous then  27047 would be ok , if it said subcutaneous but subfascial -like into the muscles then 27048 would be a better selection, please if you dont mind explain the difference . thank you -
27047 has to be beyond subcu-?, but it says subcu, 27048 , i thought was beyond subcu


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## magnolia1

This procedure was done on the "buttocks", not in the pelvis/ hip region.

The code choices we are given in regards to "excision depth" depend on from where anatomically the lesion is being removed. 

Does that help?


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## codedog

yes, thanks


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## akandrew

Based on the operative report, I would report 27043, 3 cm or greater,  because the buttocks are considered the pelvic area and it does state subcutaneous. If you read the section in the coding guidelnes for the musculoskeletal system, there is a paragraph that gives direction for excision of subcutaneous soft tissue tumors.  I hope that helps.

Arlene Andrew, CPC, CPC-I


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