Ob-Gyn Coding Alert

Question: I need a CPT® code for perineal cystectomy. The doctor’s note states, “1.5cm firm nodule in the mid perineum.” Am I looking at a code from the integumentary system? Or female genital section? The doctor uses the term “cystectomy,” but the perineum is part of the vulva, so is cystectomy similar to vulvectomy?

Tennessee Subscriber

Answer: You will look to excision of cyst, external genitalia for this (by size). In this case, you should report 11422 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm). A vulvectomy, which involves removing the labia, and/or clitoris and/or other structures of the vulva other than a discrete lesion, is not a cystectomy. Cystectomy is a general term for the excision of a cyst. In this case, the physician excised a skin cyst on the perineum, which is part of the external genitalia. Therefore, the integumentary codes are the most correct to describe the procedure.