Otolaryngology Coding Alert

Since no site-specific code exists for preauricular cyst removal and repair, you have to identify the procedure's type of closure -- or you could overlook capturing a second integumentary code.

To home in on the appropriate code(s), look at whether the surgery involves excision with simple, layer, or complex closure, or a more complex closure accomplished with a tissue transfer or rearrangement. Then, code the preauricular cyst claim using these rules:

Excision: For preauricular cysts that involve simple closure, use the excision benign lesions of face codes (11440-11446).

Complex closure: If the surgeon uses a layer (12041-12057) or complex closure (13131-13133), code both the closure and the benign lesion excision, and report the procedure with more relative value units (RVUs) first.

More complex closure: "If the closure is some type of tissue transfer, then code the closure [14040-14041]," says Janet Kidneigh, at The Children's Hospital in Aurora, Colo. The flap includes the excision. So, you do not code the cyst's excision.

Report a local rotation tissue flap, as described in the op report on page 81, with 14040 (Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; defect 10 sq cm or less) or 14041 (- defect 10.1 sq cm to 30.0 sq cm) depending on the defect's size, notes Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.

If the surgeon does not mention the defect's size, you can only use 14040.

The procedure occurs in a previously operated field that may make the work involved substantially greater than 14040 or 14041 usually requires. Therefore, the transfer could qualify for modifier 22 (Increased procedural services), provided the documentation supports the increased service modifier. Keep in mind that 14040 is coded per defect, not per flap.