General Surgery Coding Alert

Question: My physician performed an excision due to a painful clotted vein in the lower extremity. I cannot find a code specific to this type of surgery. Is there a code that would be appropriate  than 28899? My surgeon thought maybe 27632 might work.

Codify Member

Answer: This is a difficult coding challenge without having more information. Depending on the clinical situation, there are a few codes that might be appropriate, as follows:

Code 27632 (Excision, tumor, soft tissue of leg or ankle area subcutaneous; 3 cm or greater) would be appropriate if the physician thought it was a tumor but found out subsequently it was just a clot.

If the physician had previously performed a procedure on the patient, which ended up with a painful clot, he might consider billing 35860 (Exploration for postoperative hemorrhage, thrombosis or infection; extremity).

If it was a varicose vein, you might want to look at some of those procedures such as 37765 (Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions). In this case, however, you would want to use the unlisted code 37799 (Unlisted procedure, vascular surgery) because only one vein was involved. Compare the procedure to a stab phlebectomy if that sounds reasonable when the note is actually reviewed.

Best bet: Go back to your surgeon and find out what the clinical circumstances were for this procedure so that you can choose the appropriate code.

Reader Questions and You Be the Coder were prepared with the assistance of Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program.