Otolaryngology Coding Alert

Question: I’m struggling with coding this procedure. Documentation reads, “The skin around the fistula was injected with 1% lido w/epi and prepped. A marking pen was used to design an elliptical skin incision around the opening of the fistula. A lacrimal probe was inserted into the opening and extended down to the point where the fistula ended deep and anteriorly. A 15-blade scalpel was used to make the skin incisions around the opening in the skin and then a combination of sharp and blunt dissection was used to dissect around the pouch with the lacrimal probe inside of it. The dissection was carried anteriorly to where the pouch ended and the removed completely. Sent to path. Wound cauterized, irrigated and suctioned and the closed in layers with 4-0 Vicryl sutures for the deeper layers, followed by a running 5-0 fast absorbing gut sutures to close skin.” 

I think 69700 is close to being the correct code, but that is post-auricular.

Oklahoma Subscriber

Answer: When coding a preauricular cyst or fistula tract, look at the family of 1144x (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane…). You’ll determine the exact code based on the size of the excision. 

You’ll also report a code for layered closure. Again, the specific code would depend on the size of the wound. You’ll find the choices with code family 1205x (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes…).