Epidermal Cyst

Question:

Hello, I was at an ASPS coding conference last year and loved what Kim Pollock had to say! She did a great job and was very informative, I learned a lot from her that weekend.

I have a question and was hoping you could give me some insight on it. When coding for a lesion/mass excision removal I know that you code by the size and the location of the lesion/mass but when it comes to depth I am a little confused. The patient has a ruptured epidermal cyst (per the pathology report) removed from the eyebrow/eyelid area and the doctor goes down to and included the oculi muscle to excise it. Would I code from the integumentary system (114xx) or from the musculoskeletal system (e.g., 21012-21014). I am leaning toward the excision of skin (integumentary) codes because the origin of the cyst is from the dermis or epidermis and you would code those from the integumentary system….at least that’s what I heard Kim say at the conference. But because the excision was down to and included the oculi muscle I want to make sure that I wouldn’t code it the musculoskeletal system codes.

Thanks for any help you can provide!

Answer:

Thank you for your kind words – I very much appreciate it! You’re right – you’d use the integumentary system code (114xx) in this situation because the epidermal cyst is of cutaneous origin. The codes in the musculoskeletal system (2xxxx) are for tumors that are non-cutaneous in origin such as lipomas. The depth of the excision, while it clearly makes the procedure more difficult, does not have a bearing on the code. It’s the origin of the lesion/tumor that drives the code choice.

*This response is based on the best information available as of 01/22/15.