Soft Tissue Tumors

Question:

I excised a 1 cm lipoma from the patient’s scalp and reported CPT code 21011. I also performed an intermediate repair of 1.4cm and reported CPT 12031. I submitted the claim to the insurance company, and they denied the repair. Why can’t I get paid for the repair? Is the CPT code I submitted incorrect?

Answer:

When a soft tissue tumor excision is performed, the direct closure (simple or intermediate repair) is included in the soft tissue tumor excision and cannot be reported separately. According to CPT Assistant February 2010; a complex repair may be reported when extensive undermining or other techniques are used to close the defect and the elevation of tissue planes to permit resection of the tumor is included in the soft tissue tumor excision. Adjacent tissue transfer, split-thickness/full-thickness graft, muscle flap, etc. may also be reported separately. Keep in mind, though, that some payors may include the complex repair as payment for the soft tissue tumor excision.

Source: CPT Assistant February 2010

*This response is based on the best information available as of 5/9/24.