General Surgery Coding Alert

24 revised codes single out sarcoma.

When your surgeon performs a radical resection to remove a malignant muscular/integumentary tumor, you’ll have new direction in CPT® 2014 to help you choose the proper code.

Get familiar with a small change in wording for 24 codes, coupled with a number of text notes that will help you zero in the right code every time.

Make “Malignant Tumor” More Specific

You’ll see an important change to a host of radical resection codes in the CPT® 2014 Musculoskeletal System chapter. The codes change the parenthetic tumor example from “malignant tumor” to “sarcoma.” Check out the following list to see which codes are affected by the change:

• 21015-21016 — Radical resection of tumor (e.g. sarcoma), soft tissue of face or scalp …
  
• 21935-21936 — Radical resection of tumor (e.g. sarcoma), soft tissue of back or flank …
  
• 21557-21558 — Radical resection of tumor (e.g. sarcoma), soft tissue of neck or anterior thorax …
  
• 22904-22905 — Radical resection of tumor (e.g. sarcoma), soft tissue of abdominal wall …
  
• 23077-23078 — Radical resection of tumor (e.g. sarcoma), soft tissue of shoulder area …
  
• 24077-24079 — Radical resection of tumor (e.g. sarcoma), soft tissue of upper arm or elbow area …
  
• 25077-20578 — Radical resection of tumor (e.g. sarcoma), soft tissue of forearm and/or wrist area …
  
• 26117-26118 — Radical resection of tumor (e.g. sarcoma), soft tissue of hand or finger …
  
• 27049-27059 — Radical resection of tumor (e.g. sarcoma), soft tissue of soft tissue of pelvis and hip area …
  
• 27329, 27364 — Radical resection of tumor (e.g. sarcoma), soft tissue of thigh or knee area …
  
• 27615-27616 — Radical resection of tumor (e.g. sarcoma), soft tissue of leg or ankle area …
  
• 28046-28047 — Radical resection of tumor (e.g. sarcoma), soft tissue of foot or toe …
  

Each pair of codes distinguishes between large and small tumor size, for instance of less than 5 cm, or 5 cm and greater.

Understand sarcoma: Sarcoma is a cancer that arises from mesenchymal cells, such as muscle, fat, cartilage, bone, and vascular tissue. That’s different from tumors that arise from epithelial cells, which are carcinomas.

“The change from ‘malignant neoplasm’ to ‘sarcoma’ helps clarify that you should use these codes only for malignant tumors that arise from connective tissue,” explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC, COBGC, internal audit manager at CHAN Healthcare in Vancouver, Wash.

Confusion: Without the clarification, some coders were unsure if they should use these codes for malignant skin tumors that were invasive into fascia and muscle tissue.

Follow Text Note Direction

To further clarify the distinction that you should reserve the 20000-level codes for radical resection of soft tissue tumors arising from connective tissue, CPT® 2014 adds a text note following each pair of codes revised codes.

The text note states, “For radical resection of tumor(s) of cutaneous origin (e.g., melanoma”, see…” Each note refers coders to malignant tumor codes from the Integumentary chapter for the appropriate anatomic site.

For instance: The note following 24077 and 24079 refers coders to 11600-1606 (Excision, malignant lesion including margins, trunk, arms, or legs …). The various codes in the range represent increasing excision diameters.

“Taken together, the code definition changes and text notes clarify that you should choose 10000 level codes for radical resection of malignant tumor arising from the skin, and 20000 level codes for radical resection of malignant tumor arising from the connective tissue,” says Pat Kidd, CPC, CGSC, coder and billing specialist with Samaritan Health Services in Albany, OR.