General Surgery Coding Alert

Question: Our surgeon removed a mass from a patient’s nose (1.3 cm, including margins), and the pathologist diagnosed it as a dermoid cyst. Should we report 11442 for the service?

Nevada Subscriber

Answer: Based on the diagnosis, the best procedure code to describe this service is 30124 (Excision dermoid cyst, nose; simple, skin, subcutaneous). 

If the surgeon documents that the excision is complicated because the cyst extends under the bone or cartilage, you should use 30125 (Excision dermoid cyst, nose; complex, under bone or cartilage). 

The code you listed, 11442 (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm), is not appropriate for a dermoid cyst. You’ll notice that the 11442 code descriptor states “unless listed elsewhere,” and the dermoid cyst is listed elsewhere. That makes 30124 the most specific code, and the one you should report.

Bonus: In this case, the hard work of coding correctly will pay off. Because 11442 pays $188.43 and 30124 pays $292.31 (Medicare physician fee schedule, non-facility national amount, conversion factor 35.8228), you stand to gain $103.88 for your practice.