ED Coding and Reimbursement Alert
Perineal Tumor
Question: A patient presents with a 10-centimeter perineal tumor. He is scheduled for excision of the tumor as an outpatient. The 10000 codes do not pay enough to substantiate the size and difficulty of this tumor. What CPT code(s) should be used? What ICD-9 code can I use to support higher reimbursement?
Pennsylvania Subscriber
You might try adding modifier -22 (unusual procedural services) to indicate an unusual procedural service. You probably will have to provide operative notes to the payer to support this. In terms of ICD-9 coding, you can wait for the biopsy report to determine what code you want to use, but there are no set or prescribed codes that result in increased payments.
Source for You Be the Coder is Laura Siniscalchi, RRA, CCA, CCS-P, CPC, education coordinator for Beth Israel Deaconess Medical Center in Boston.
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