General Surgery Coding Alert

Think every large lesion that extends deeper than the dermis is a soft tissue tumor? Think again.

Don't make an upcoding error that could land your practice in hot water. Follow these tips to ensure that you distinguish new CPT 2010 musculoskeletal soft tissue tumor codes from procedures better described by integumentary entries.

Soft tissue tumor excision codes and skin cancer treatment codes aren't interchangeable based on size or even depth of excision. With rare exceptions, you should use integumentary codes for skin cancers, and save the new 20000 series soft tissue tumor codes for lesions that do not arise in the dermis.

Origin is key: To use the new excision codes, the tumor should stem from the musculoskeletal system, extend through the white fat subcutaneous layer, and not be a tumor that originates in the skin, according to John P. Heiner, MD, professor at University of Wisconsin Hospital and Clinics in Madison at the CPT and RBRVS 2010 Annual Symposium in Chicago. "For skin tumors, you should be in the 11000 series."

Follow text note: To ensure that you don't misuse the new codes, CPT provides this instruction in the revised musculoskeletal system introduction: "For radical resection of tumors of cutaneous origin (e.g., melanoma) see 11600-+11646."

If your surgeon removes a malignant melanoma that extends into the muscle, should you use the new soft tissue tumor resection codes? Almost never, says Heiner. Even if the tumor is deep, the vast majority of the time you should select from the integumentary codes for a melanoma excision.

The new codes in the 20000 series are for soft tissue tumors, such as sarcomas and lipomas.