Otolaryngology Coding Alert

Question: The otolaryngologist performed an open excision of a 3 cm tumor located in the right deep neck space tumor/skull base. She would like to report 61605 but the approach is not included. The approaches listed for other codes in the same CPT^® section 61590-61592 do not match what she performed; she used a cervical approach to get to the lesion attached to the skull base. I’m leaning toward submitting either 21554 with modifier 22 or an unlisted code with notes. What would you recommend?

South Carolina Subscriber

Answer: From the information you give, the most appropriate code that fits this scenario is 21556 (Excision, tumor, soft tissue of neck or anterior thorax, subfascial [e.g., intramuscular]; less than 5 cm). Code 21554 (Excision, tumor, soft tissue of neck or anterior thorax, subfascial [e.g., intramuscular]; 5 cm or greater) would not be appropriate because it represents a tumor greater than 5 cm, and the one in your case was 3 cm.

You’re correct in thinking that code 61605 (Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; extradural) cannot be used because your provider used cervical approach to remove the deep neck tumor whereas 61605 represents auricular incisions.

The coding for this service cannot be fully accurate without reviewing the operative note.  If the tumor was in a difficult location and the operative note reflects the increased complexity from a direct neck tumor excision, the 22 modifier (Increased service) should be considered for addition to the code used.