Urology Coding Alert

Reviewed on May 27, 2015
Question: My urologist performed an excision of a sebaceous scrotal cyst, and I reported 55899. The carrier denied the claim, even when I sent the operative note with it. Am I reporting the wrong code for this procedure?


Illinois Subscriber
Answer: Unfortunately, you are reporting an incorrect code for the procedure you’ve described. There’s a better coding option than the unlisted-procedure code 55899 (Unlisted procedure, male genital system). If you look at the notes in the scrotum excision portion of the CPT® manual, the guidelines direct you to the integumentary system section of codes for “excision of local lesion of skin of scrotum.”

Best bet: Turn to codes 11420-11426 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia ...). The code you select depends on the documented diameter of the total amount of scrotal skin the urologist had to remove in removing the cyst, not the diameter or size of the lesion itself.

Tip: If the excision was complicated or “unusual,” CPT® directs you to add modifier 22 Increased procedural services) to indicate that the urologist spent additional time and/or effort on the procedure.

Also, if the closure of the defect involved more than a single layer, you may be able to add an additional code to describe the repair of the defect from the code series 12041-12047 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia ...) for layered closure or from the code series 13131-13133 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet ...) for a complex repair, such as a complex tissue re-arrangement.

Diagnosis: Depending on the clinical findings, there are many diagnosis codes you may use when removing skin lesions. In this case, ICD-9 code 706.2 (Sebaceous cyst) would be the correct diagnosis. For ICD-10, report L72.3 (Sebaceous cyst). However, for many payers it is not enough to link the procedure codes (11420-11426) to a correct payable diagnosis code.

The medical necessity for the removal of a cyst must also be indicated with symptoms such as pain, bleeding, trauma, infection or inflammation, or suspicion of malignancy. You must list these clinical signs and symptoms necessitating cyst removal in the medical records as well as on the 1500 form as secondary diagnoses to ensure payment for the procedure.

Payable signs/symptoms as secondary codes include 459.0 For ICD-10, report R58, 682.0-682.9 For ICD-10, report L03.---, 686.8 For ICD-10, report L08.89, 686.9 For ICD-10, report L08.9, 692.9 For ICD-10, report L23.9, L24.9, or [...]