Tanesha Posted Tue 06th of March, 2018 17:17:20 PM
Finger mass dx. on op report ,but path states something different. Do I code 26989 for the synovial tissue removal or a regular benign lesion excision (depending on size of course)? The path states "Left index finger mass, biopsy: Fragments of synovial tissue with focal features consistent with gout." Comment:
The sections show synovial tissue with a focal area in which there is
lightly eosinophilic amorphous debris with surrounding palisading
histiocytes, which is the histologic appearance associated with gout.
OP REPORT : Finger tourniquet was applied, though this was not rolled down the finger to avoid popping the mass.
Next, an oblique incision was made overlying the mass. This was isolated from the flexor tendon sheath. The digital nerve was dissected away from the mass. Wound was irrigated. Tourniquet was removed. Hemostasis was obtained with bipolar. Wound closed with nylon. Sterile dressing applied.
SuperCoder Answered Wed 07th of March, 2018 03:08:37 AM
As per supercoder 26989 is not appropriate, as the provider is doing excision of finger mass. The appropriate excision code depends largely on the size and depth of the excised tumor. CPT® provides specific codes for masses smaller or bigger than 1.5 cm in diameter that sit just underneath the skin (subcutaneous) or that are deep within the muscle or tissue (subfascial). Choose the appropriate excision code as per size for subfascial.
Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; 1.5 cm or greater
Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); 1.5 cm or greater
Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; less than 1.5 cm
Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cm
Hope that helps!
Tanesha Posted Wed 07th of March, 2018 13:34:22 PM
26989 (unlisted) was the code for the excision of the synovial tissue in the finger. That code didn't feel right for this particular scenario (although that was what excised) so thank you for responding a timely manner.
SuperCoder Answered Thu 08th of March, 2018 06:40:33 AM