# Transordal resection of parapharyngeal space mass - help!



## mlh2000ku (Jun 4, 2018)

I am not sure how I should be coding this?  I was looking at code 21555?  I am thinking there should be a more specific code for this? Below is the description:  Any help would be greatly appreciated!! 
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We placed the trocars in the robotic and camera arms and then placed the 0 degree camera and both the retractor and the bovie cautery in the robotic arms. **Once we were in good position with the robot, I moved to the robotic console at the patients head. I first palpated the tumor and the infrrior aspest was at the superior aspect of the left tonsil and this extended into the soft palat on the left side.  I marked out an incision with a marking pen form the superior tonsillar fossa into the left lateral soft palate.  I then made the lateral tonsillar pillar incision and incised through the superior constrictors to expose the tumor. I developed a plane below the pharyngeal constrictor. *I elevated this plane medially and laterally around the tumor which was well encapulated. *Once I felt the superior, inferior, lateral and medial margins were exposed, I went to the head of the bed and performed blunt finger dissection of the posterior aspect of the tumor. The tumor ruptured anteriorly due to the pressure of dissection but I felt the capsule as well as the content of the tumor were removed in its entirety.  We sent this to pathology for frozen section analysis.  It was read a pleomorphic adenoma.  We irrigated the wound with copious amounts of saline irrigation.  I then brought the robot back in and placed the arms in good position.  I used the robot to close the incision site with 3-0 vicryl suture in an interrupted pattern.  Once the incision was closed, I backed the robot away.  
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## cpc2007 (Jun 22, 2018)

I would code this case with CPT 42808. This code includes excision or destruction of lesions of the pharynx (and the tonsil pillars are at the start of the pharynx). This code also describes the intraoral approach (through the mouth) that your surgeon used to gain access to the tumor.  I wouldn't code 21555 because this is for a soft tissue tumor excision from the subcutaneous tissues in the neck or thorax and this lesion is actually at the entrance to the throat.  If the insurance company also recognizes code S2900 for robotic surgery you could add that in addition to 42808 (I know Medicare generally does not recognize this code as separately reportable but some private insurance companies do). 

I hope that helps 

Have a good night
Kim
www.codingmastery.com


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## mlh2000ku (Jul 12, 2018)

Thanks so much!


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