Urology Coding Alert

Question: My doctor did an excision of a perineal sebaceous cyst. How should I code this?

Nebraska Subscriber

Answer: You should report a code from the 11420-11426 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia ...) series for the excision. You'll select the proper code based on the size or amount of tissue (circumference) the urologist removed (the lesion size and the surrounding margins).

Use 706.2 (Sebaceous cyst) for the sebaceous cyst and 229.8 (Benign neoplasm of other and unspecified sites; other specified sites) for the location in the perineum. You will need to also report another diagnosis code that is based on your urologist's documentation indicating the medical necessity for the sebaceous cyst removal . For example, you might report 459.0 (Hemorrhage, unspecified), 686.8 (Other specified local infections of skin and subcutaneous tissue) or 686.9 (Unspecified local infection of skin and subcutaneous tissue), 695.9 (Other specified erythematous conditions; other), or 782.0 (Disturbance of skin sensation). These diagnoses show medical necessity for the excision and ensure payment.

Without the additional diagnosis codes, many payers, including Medicare, will not reimburse you for the excision.