Ob-Gyn Coding Alert

Question:  Our ob-gyn performed excision vulvar hidradenitis. A navicular incision was performed since the induration extended to the superficial layer of the skin. Care was taken to separate the non-affected tissue from the hidradenitis below, including all of the small tracks that were noted. The area was app. 4 cm in length and 3 cm in width. The subcutaneous tissue was irrigated and reapproximated using 3-0 Vicryl in a series of simple sutures followed by the skin being reapproximated using 4-0 Vicryl in a subcuticular stitch.

The path report states, “Previously ruptured, severely acutely and chronically inflamed sebaceous cysts.” Since the path report does not document Hidradenitis, I know that 11470 would not be correct. Should I use 1142x? This does not feel like this is enough due to depth, sinus tracks, etc. CPT® 56620 is certainly not documented. What should I do?

Tennessee Subscriber

Answer:  You should report 11424 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm) — as this was 4 cm not over 4 cm. However, make sure the path report does not extend the sample past the 4 cm mark, since to remove that, he would be also doing margins, which means you could code up to the next size code 11426 (…; excised diameter over 4.0 cm). 

Also, he did an intermediate, not a simple repair. That means you can also code 12042 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm) for that.