# Excision distal coccygectomy and perineal cystic mass



## marycpc (Apr 9, 2012)

I need help coding this. Any assistance would be appreciated.

The op reads as follows:

After the patient was intubated, she was rolled in the prone jackknife position. Care was taken to avoid traction to her brachial plexus. Her buttocks were then prepped in the usual sterile fashion. An Ioban dressing was placed over her buttocks and perineum to keep the ans isolated from our incision. A pericoccygeal incision was made, sharply carried down to the skin and subcutaneous tissues to the cystic lesion. We dissected all around the cystic lesion trying to encompass the rim of normal fatty tissue around this and it was adherent and stuck right on the tip of the coccyx. I do not know if it was actually a part of it or not, but I decided to remove approximately distal 2 cm of coccyx.After this was done the wound was copiously irrigated. All dissection planes were inspected and seen to be hemostatic. The wound was then closed in layers. Two deep layers of interrupted 2-0 Vicryl stitches, a running 3-0 Vicryl and a deep dermal 3-0 Vicryl stitch. Dermabond was placed over the skin. The patient was then allowed to roll back supine. Dermabond was allowed to dry. The patient was taken to the recovery room in stable condition having tolerated the procedure well.

I thought 11406 and 27080? But only part of the coccyx was removed. Please help.

Thanks bunches! Mary


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## Lujanwj (Apr 12, 2012)

I'd try 27080.  Code doesn't state Complete or Partial just -ectomy.  Removal of the lesion would be incidental to the more extensive procedure.


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## colorectal surgeon (Apr 12, 2012)

Oh I wouldn't use 11406.  That's not right here. I code these as 49215 which is a pre sacral tumor excision.  There's plenty of different types of tumors in this category and a cystic lesion certainly fits.  Your doctor will appreciate you! I'm not sure if coccygectomy is bundled with this code or not.  I wouldn't think so.


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