Urology Coding Alert

Question: Is a cyst the same as abscess so far as for picking a procedure code? I know medically they are two different things; however, I am unable to locate a code for "excision of multiple sebaceous cysts using electrocautery."

Arizona Subscriber

Answer: When the urologist is removing sebaceous cysts, you should choose a code from the 11420-11426 range (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter ...). Choose the exact code based on the excised diameter or specimen size removed, not on the lesion size alone. Also, remember to bill separately for each sebaceous cyst your provider removed.

How to measure: Do not count only on the size of the lesions removed. For coding purposes your urologist should document the excised diameter, which is the lesion size (in centimeters) plus two times the smallest surrounding margin removed.

The primary diagnosis for this procedure should be 706.2 (Sebaceous cyst). You also need to include at least one secondary diagnosis from the following codes to indicate the medical necessity for the excision(s):

• 459.0 -- Hemorrhage, unspecified
• 686.8 -- Other specified local infections of skin and subcutaneous tissue
• 686.9 -- Unspecified local infection of skin and subcutaneous tissue
• 695.9 -- Unspecified erythematous conditions
• 782.0 -- Disturbance of skin sensation ... burning... numbness, tingling, paresthesia...

For Medicare and most other payers, you must include a secondary diagnosis to indicate the medical necessity for the removal of the cyst. Without a secondary diagnosis, you may not be paid for the excision.