# cyst excision



## lizard (Sep 9, 2013)

cyst excision - please help! driving me bonkers!
Op report says:
dx-groin pseudocyst containing old hematoma
Indication-post lap ing hernia repair. He has developed a large swelling in the groin.
Operative findings-large pseudocyst with thickened wall. This was excised.
Description of procedure-Ilioinguinal nerve block. local anesthetic infused in the skin and subq. 6cm incision was made parallel to the inguinal ligament extending from the pubic tubercle towards the anterior/superior iliac spine. Dissection was taken down dividing the Scarpa's fascia in the process. The external oblique fascia was identified, it was incised, and this was extended through the external ring with Metzenbaum scissors. The pseudocyst was identified and circumferentially dissected free from the surrounding cord structures. It was then excised at its base where it was attached to the transversalis fascia at the direct space. There was no hernia identified at this space. It was opened. There was blood, but no other contents other than some fibrionous exudate. The cord structures were identified. The vas and the spermatic vessels had been preserved. The ilioinguinal nerve was preserved as well during the dissection. Fascia was approximated. Skin closed followed by Surgiseal

Dr. wants to use 10140. Sounds like more to me. Excision for one thing. Any help appreciated.


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## koatsj (Sep 9, 2013)

What about looking at excision of soft tissue of pelvis/hip? Based on size of excision and how deep he went, you could go with 27043-27048?


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## lizard (Sep 9, 2013)

I have had this dilemma before... I want to use those codes but they specifically say tumor and I looked at the path report and this is indeed a cyst. What do you do when it is a deeper mass,cyst ect. excision but not a tumor?


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## lizard (Sep 12, 2013)

any thoughts on this from you surgery coders? I need some other opinions please.


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## BEARDOG (Sep 12, 2013)

A tumor does not mean it is malignant, and it can also be defined (per Stedmans) as "a swollen part; a swelling". 

I would have no qualms using the 27xxx range of codes as appropriate for size and location of the lesion removed.   It is certainly more than an I & D. Just make sure the ICD is also apprpriate.


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## FTessaBartels (Sep 12, 2013)

*Agree - 27XXX*

Agree with Beardog and koatsj ... code from the musculoskeletal section.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## lizard (Sep 16, 2013)

Thank you so much for your suggestions. This whole "tumor" thing has really got to me. It has been one of those things that the more I researched it the more complicated it became. A lot of opposing ideas.
Thanks again


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