Wiki Excision of 20mm vulvar cyst

[brandichinn24]

Hello!
I am preparing for the CPC examination sometime in the next six months and I am going back over my coding workbooks from the summer of 2012. In my CPT workbook, I am struggling with a CPT case.

The diagnosis is an enlarging right vulvar cyst.

Reason for surgery: This 34 - year old patient has a vulvar cyst that is causing pain and discomfort. The patient was taken to the operating room and placed in the supine position. An IV analgesia was started, and then she was ploaced in the dorsal lithotomy position. The surgical site was prepare with lidocaine 1% and then epinephrine and bicarb was administered. A 20-mm cyst was seen on the medial right upper labia minora. A #15 blade was used to maek a 1.2 cm incision, freeing the cyst. The cyst was removed. The area was closed wtih 5-0 Vicryl running interrupted sutures. The patient tolerated the procedure. She was placed back in the supine position and then transferred to the recovery room in satisfactory condition.

I have tried to google the answer and even read the guidelines to come up with the answer. The closest thing I can get to is complex repair, however I was thinking to do that , I needed to convert the 20 mm cyst to cm and then put an add-on code of 13133 to 13131. It is not a tissue transfer becuase it states there was no tissue transfer just the excision and at first I thought it was a 5000 code becuase of it being the female reproductive system. I'm just not sure. Could someone please explain to me how to code this? Thanks!

Brandi Chinn

 

[ciarahertzog]

I have a very similar surgical case in which my surgeon excised a 3cm labial cyst and was very specific in her report that it was NOT a Bartholin's gland cyst. There are no codes in the vulvar excision section for a cyst removal (other than Bartholin's) and this cyst was of the labia so that rules out the vaginal cyst excision code of 57135.

The code I have settled on is 11423: Excision, benign lesion including margins...genitalia; excised diameter 2.1 to 3.0cm. I think that you would use 11422 for a 2cm cyst. In the beginning of the "Excision-Benign Lesions" guidelines it states that lesion refers to "neoplasm, cicatricial, fibrous, inflammatory, congenital, CYSTIC lesions", so I think this is the code set to chose from for a cyst of the vulva.

Because my doctor notes her closure was performed in layers I am also using the intermediate repair code 12032. In your notes it sounds as if the closure is simple, so it would not be coded separate from the excision.

After reading all the options and guidelines I THINK that I have chosen the correct codes, but if anyone else has any opinions that could help I would like to hear them so that I know I am on the right path.

I hope this information helps.

 

[csperoni]

I know it's a year & a half later, but I just came across this. I agree with the 1142x recommendation based on the size of the excision if benign. However, for the intermediate repair of external genitalia, the correct code set is 1204x. If the repair were complex, then 1313x