Otolaryngology Coding Alert

Question: Which CPT code should I use for pre-auricular sinus excision?

Nebraska Subscriber

Answer: Code selection depends on the excision's depth, size and closure type. For surface cysts that involve simple closure, you should report a lesion excision code (11440-11446). Select the correct code based on the excision's size. If your otolaryngologist excises a skin-level pre-auricular cyst that measures 2.0 cm including margins and closes the wound with simple closure, you should report 11442 (Excision, other benign lesion including margins [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 cm to 2.0 cm).

For repairs that involve layered (12051-12057) or complex closure (13131-13133), you should report excisions larger than 0.5 cm (11441-11446) in addition to the repair code. The National Correct Coding Initiative  bundles 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) into 12051-12057 and 13131-13133. Suppose the otolaryngologist in the above example also uses and documents layered closure. You should report the repair (12051*, Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) and append modifier -51 (Multiple procedures) to the excision (11442).

You should instead use 42810 (Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues) or 42815 (Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx) for deeper cysts. For a pre-auricular cyst that extends down to the subcutaneous level, you should report 42810. If the sinus goes below the subcutaneous, you should assign 42815.