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Excision of Preauricular Pit including Cartilage

Maria Posted Thu 10th of July, 2014 14:43:50 PM

How should the following procedure be coded?

An elliptical incision was made around the pit and carried down through the subcutaneous tissue. The pit was carefully dissected down to the helical rim and a portion of the cartilage was removed. Once the pit was excised, the wound was closed with 5-0 Monocryl deep suture, 6-0 fast absorbing gut to close the skin and Dermabond.

Seems more than simply Integumentary System procedure, but not part of the Digestive System or Auditory Systems, either.

Thank you for your help!

SuperCoder Answered Sun 13th of July, 2014 10:36:43 AM

Thanks for your question. Use code 42810.

Preauricular pit is also known as "Preauricular cyst" is a common congenital malformation characterized by a nodule located anywhere adjacent to the external ear. It result from developmental defects of the first and second branchial arches.

For excision of a preauricular cyst that extends to the subcutaneous level, you can use 42810 (Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues).

Thanks !!

Maria Posted Mon 21st of July, 2014 19:12:22 PM

Please see the "Code This Excision" exercise in the Otolaryngology Coding Alert, March 2012. In part, it states,"Identifying whether the cyst excision was in the neck or ear region avoids using a code from the incorrect CPT anatomy section...Link Branchial to Neck's 42810-42815." And, "Think Ear for Preauricular Cyst"..." should use 42815 when the cyst is in the neck and around the tonsil area."

Does this mean that the appropriate code is from the Integumentary System, since the Auditory System does not have any "PRE-auricular" excison codes?

Thank You!

SuperCoder Answered Mon 28th of July, 2014 02:51:50 AM

Coding will depend upon the exact anatomy of cyst. (Check in operative report or consult provider).

The preauricular area is on the side of the head just in front of the ear. When coding preauricular cyst or sinus removal, use 1144x (excision, other benign lesion [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane) should be billed (the exact code would be determined by the size of the excision), along with a layered closure (1205x, layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes). Again, the specific code would depend on the size of the wound.

For branchial cysts, you-ll be in the neck section. "Branchial cleft cysts are congenital cysts that arise in the lateral aspect of the neck when the second branchial cleft fails to close during embryonic development". You should use 42810 (Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues) when the branchial cyst is superficial. If the provider dissects all the way to the tongue base or tonsillar pillars, report 42815 (Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx).

Hope it helps. Thanks !!

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