General Surgery Coding Alert

Question: A patient had a left infected third branchial cleft cyst. The surgeon incised, drained, and took a culture specimen from fluctuant area. He debrided overlying skin that was necrotic and friable. The surgeon identified and removed keratinized debris from the cyst, then debrided and cauterized base of the abscess/cyst wall. Is this "incision and drainage" (10060) or is there a more comprehensive code for this work?

Texas Subscriber

Answer: The correct code for the procedure you describe is 42810 (Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues).

A branchial cleft cyst is a congenital malformation that forms in the neck when the branchial cleft does not close as it should during embryonic development. Although often benign, the cyst may become infected and require removal. The most specific code to describe the procedure is 42810.

Although the surgical report notes that the surgeon "incised and drained" the cyst, the code you mention describes incision and drainage of skin lesions (10060, Incision and drainage of abscess [e.g., carbuncle, suppurative hidradentitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single), not a branchial cleft cyst.

The procedure that your surgeon performed involved more than simple incision and drainage, but even the more complex skin code is not appropriate (10061, ... complicated or multiple).

Key: The type of cyst (branchial cleft cyst) dictates that you select 42810, not 10060 or 10061, for your surgeon's work.