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Enlarging mass

Lina Posted Mon 13th of October, 2014 14:37:06 PM

Need help please
1 Excision of intramuscular subfascial multilobulated mass from right side triangle of the neck
2. Preservation of the spinal accessory nerve
3. Excision of enlarge lymph node

SuperCoder Answered Tue 14th of October, 2014 03:27:46 AM

Thanks for your query!

CPT codes suggestion is based on one line description of procedure in your query, you should review procedure performed in detail to infer correct CPT codes.

1. You can report 21556 for intramuscular mass excision from neck area. You must pay attention to the size, if mass is greater than 5 cm, you must code 21554.

2. You must go through description of procedure to verify excision of all cervical lymph nodes (radical) done along with preservation of spinal accessory nerve, in that case you can report 38724 (Modified radical neck dissection with cervical lymphadenectomy).
However, if only one or few enlarged lymph node/s were excised, you must code CPT 38510.

Hope this answers your query.

Thank you!

Lina Posted Tue 14th of October, 2014 10:06:47 AM

THANK YOU

SuperCoder Answered Tue 14th of October, 2014 14:48:31 PM

You are welcome!

Lina Posted Tue 11th of November, 2014 11:54:04 AM

HI
I billed 21554
38724 59

and got paid for only "21554" stating that "38724" is included in the code 21554
should I send for an appeal?
Thank you

SuperCoder Answered Wed 12th of November, 2014 10:08:48 AM

Thank you for your query.

Both CPT codes 21554 and 38724 bundle as per NCCI edits and only 21554 should be reported. However, you can look for documentation which supports lymph node removal (38724) separate from mass excision (for e.g. separate incision, separate site etc). If there is no documentation available to support multilobulated mass excision from lymph node excision, then billed code 21554 stands correct and you can skip appealing.

Hope it clarifies.
Thank you!

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