# Endoscopy unlisted



## Jamie Dezenzo (Jun 3, 2010)

Hello all,

I'm looking at unlisted but not sure which area to use.

ENDOSCOPY excision of forehead bony neoplasm

21499 or 29999?

Thanks....new one for me


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## mitchellde (Jun 3, 2010)

I do not think you can excise a forehead bony neoplsm with an endoscopic approach!  Can we see the whole procedure note?


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## Jamie Dezenzo (Jun 3, 2010)

*op note*

The trichophytic incision was made and beveled appropriately to allow the hair to regrow through the scar. The incision was then carried down to the periosteum. The subperiosteal plane was developed. A sheath and 30-degree endoscope was brought in. The lesion was visualized. Using a curved osteotome, it taken flush with the frontal bone. The neoplasm was removed and sent for pathologic evaluation. Adequate hemostasis was ensured. the contour of the frontal bone appeared very smooth. Therefore, no additional rasping or drilling was necessary. The incision was then closed in layers using 4-0 Monocryl for the deep tissues followed by a running, subcuticulare 4-0 Monocryl suture.

Path not back yet and Medicare patient


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## mitchellde (Jun 3, 2010)

I see what they did but I think you should use an regular open proceure code for this.  What it looks like to me is to spare the patient a huge scar they made the incision and then use a scope to get a look at the exact location and then used the osteotome.  So the scope was just to get a better look.  You may have enough for the use of a 22 modifier.  I do not have my CPT book handy for the procedure code but I would look for an open code in the forehead section.


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## Jamie Dezenzo (Jun 9, 2010)

ok path came back "osteoma"

similar code 21029....21299 compare to 21029


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