Primary Care Coding Alert

If you've been stuck before on choosing excision codes because it just won't fit between radical excisions or skin lesion codes, CPT 2010 will make your work easier and more specific with a slew of new codes targeted at specifying the depth and size of the family physician's work.

Watch out for terms "subcutaneous" and "subfascial," because this will mean greater specificity for you and your payers. Documenting the size of the excision will also help you avoid reporting lesser codes and therefore smaller payouts. Check out these new codes and be prepared to start reporting them for 2010.

As of Jan. 1, you will have four new face and scalp tumor excision codes to add to your arsenal. They are:

• 21011 -- Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm

• 21012 -- ... 2 cm or greater

• 21013 --  Excision, tumor, soft tissue of face and scalp, subfascial (e.g., subgaleal, intramuscular); less than 2 cm

• 21014 -- 2 cm or greater.

Codes 21011-21012 are for subcutaneous tumors, and will be used based on the tumor's size, either less than 2 cm for 21011, or 2 cm or greater for 21012. Codes 21013-21014 are for subfascial (for example, subgaleal, intramuscular). For subfascial tumors that are less than 2 cm, use 21013; use 21014 for tumors that are 2 cm or larger.

"I think it's fantastic that we now have these new codes," explains Linda Vargas, CPC, coding and reimbursement specialist for Cass Regional Medical Center in Harrisonville, Mo. "Previously, we had a code only for radical excision, and were left with using skin lesions codes, which didn't always seem fair. These codes give us more options."

"Per 2010 CPT (expert), these codes are for simple and marginal resection for most likely benign tumors that do not involve bone," Vargas adds. "The codes include simple and intermediate repairs, but CPT does not include complex repair."

CPT also expands these changes to involve other anatomic areas. You'll find similar new code additions and revisions specifying size and subcutaneous/subfascial when coding for Excision, tumor, soft tissue of:

In most cases, these codes, especially those for subcutaneous excisions, specify less than 3 cm or 3 cm or greater. The "subfascial" codes for the neck or anterior thorax (21554, 21556), back or flank (21932, 21933), abdominal wall (22900, 22901), shoulder (23073, 23076), and upper arm or elbow (24073, 24076), however, specify less than 5 cm or 5 cm or greater. Also, the excision codes for the foot or toe specify less than 1.5 cm (28043 for subcutaneous or 28045 for subfascial) or 1.5 cm or greater (28039 for subcutaneous or 28041 for subfascial). Your family physicians must distinguish and document the excised size so that you can choose the appropriate code.

Specification of "subcutaneous" or "subfascial" also helps provide a clue that the new and revised codes in the musculoskeletal section should be used, rather than the excision of lesion codes in the integumentary section (11400-11446, 11600-11646). CPT integumentary excision codes guidelines indicate that excision in this context "is defined as full-thickness (through the dermis)," which is the layer of skin above the subcutaneous and subfascial. So, if "subcutaneous" or "subfascial" is specified, you know that you need to look outside the integumentary excision codes.

In addition, you also have the following excision of tumor or vascular malformation codes:

• *26111 --  Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; 1.5 cm or greater•

*26113 -- Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (e.g., intramuscular); 1.5 cm or greater

• 26115 -- Excision, tumor or vascular malformation,soft tissue of hand or finger, subcutaneous; less than 1.5 cm

• 26116 --  Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (e.g., intramuscular); less than 1.5 cm

* These are new codes.The other two are revised to allow two size-based codes.