# Neck mass -1144x?-vs 21555



## codedog

When coding excision neck mass , the operative report says the excision went down through the skin and subcutaneous tissue. IT appears to be an epidermal inclusion cyst. cpt code 21555 says sub, and 1144x  also says it also. Does it depend on the outcome of pathlogy report.?Please help.


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## RebeccaWoodward*

Without seeing an op note, I would be inclined to go with 21555.

21555=Md removes mass from soft tissue of neck that is located in the subcutaneous tissue and in the deep soft tissue... 

1144* doesn't seem to fit for me.


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## mbort

I agree with Rebecca, definitely 21555


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## evonp

*Evon Pefaur, CPC*

Given your description of a neck mass - I would go with the 21555 . This code is for excision of a neck mass where removal is subcutaneous. The extended descriptor reads "...the physician removes the mass from the soft tissue of the neck that is located in the subcutansous tissue" (from ENT Coding Companion/Ingenix). The 1144x code is more of a derm code for lesions as opposed to a mass. The extended desriptor for this codes reads "physician removes a benign lesion from xxx...The physician makes a full-thickness incision thru the dermis... around and under the lesion and removes it". I would review the op note to see which fits better but I am leaning toward 21555.

Evon Pefaur, CPC
ENT


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## codedog

*here is op note*

operative notes states


Dx- Right posterior neck mass, clonical epidermal inclusion cyst. 

Procedure- An incsion was made directly over the area in a vertical fashion was made foraround 2 cm. Dissection was carried down through skin and subcutaneous tisue. It appeared to be an epidermal inclusion cyst, and it was dissected out. There was no nervous tissue identified and was looked for. It was  removed with the entire sac. Pressure was held for one minute, and there was no hemorrahaging.  The skin was closed with 4-0 vicryl in a subcuticular fashion, and steri strips were placed
    thanks


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## RebeccaWoodward*

21555


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## codedog

rebeccawoodward said:


> 21555



Thanks rebeccawoodwardard , and everone else.now I understand


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## Tauni_Carter

Does this include two layer closure?


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## Jamie Dezenzo

Per CPT ASST 4/2010

Question: What would be the appropriate CPT code for excision of a sebaceous cyst on the scalp or on the face that is subdermal or deeper?

Answer: Integumentary lesion excision codes pertain to the epidermis, dermis, and subcutaneous tissue, while musculoskeletal lesion excision codes pertain to subcutaneous, superficial or deep soft tissues. Code ranges 11400-11446 and 11600-11646 represent lesions that normally occur on the surface of the skin (epidermis) or near the surface of the skin (dermis), compared to the type of lesion (or tumor) that occurs in the subfascial or fascial tissue, muscles and joints, as listed in the musculoskeletal section. _*A sebaceous cyst is a skin lesion and may be very large, distending the skin and pushing into the subcutaneous fatty tissue, but it is a skin lesion, and therefore, should be coded using the integumentary lesion excision codes, depending on the size of the cyst.*_


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## bethh05

Jamie is correct, a pilar or epidermoid cyst is coded using Integumentary.


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## mitchellde

It really does depend on the point of origin, in the case of the documentation you have a epidermal cyst does originate in the epidermal tissue and may extend upward and/or downward but it is within the intergumentary system.  orginating below the dermal layer is musculoskeletal.


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