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Guidance needed

louise Posted Mon 28th of October, 2019 13:59:47 PM
1. Hardware removal - anterior mandible 20680. Fistulectomy of left submental fistula ???? 3. Nasalseptorhinoplasty 30520 4. 2 cm epigastric sebaceous cyst, 6cm left chest wall subcutaneous lipoma 11402 21552 12031
SuperCoder Answered Tue 29th of October, 2019 07:40:39 AM

Hi Louise,

1. Hardware removal - anterior mandible 20680.

In CPT 20680, surgeon extends the incision by dissecting through fascia and muscle layers to access the deep bone implant, such as a rod, pins, wire, screw, metal band, nail, rod, or plate. When he identifies the deeply inserted implant, he unscrews the implant, dissecting it from surrounding tissue as necessary. He extracts the deep implant by pulling it out with sharp forceps. He closes the wound with layered sutures. Seems appropriate for anterior mandible hardware removal.


2. Fistulectomy of left submental fistula ????

There is no specific defined code for the submental fistula repair. Hence, CPT 21899 (Unlisted procedure, neck or thorax) can be coded. When reporting a procedure with an unlisted code, submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis, and they will determine payment based on the documentation you provide.


3. Nasalseptorhinoplasty 30520

In CPT 30520, the physician makes a Freer's hemitransfixion incision or a Killian incision depending upon the area of septum affected. The cartilaginous and bony septum is then exposed, and the mucosal flap is elevated. A tru–cuts is used to remove the irregular bones and cartilage. The flaps are then returned to their normal position. The incision is closed with sutures and the physician applies a splint. Graft being used in this procedure. On the other hand, if graft not being used septoplasty, then CPT 30620 is appropriate to bill for Septal or Other Intranasal Dermatoplasty. Seems appropriate for defined procedure.


4. 2 cm epigastric sebaceous cyst, 6cm left chest wall subcutaneous lipoma 11402 21552 12031

CPT 11402 and 21552 are appropriate for "Excision of benign lesion for trunk" and "Excision of subcutaneous soft tissue tumor of anterior thorax", respectively. Usually, intermediate repair required when there is subcutaneous being performed. So, CPT 12031 might not require when billing the CPT 21552. However, CPT 12031 is a column 2 code for 21552, but you may use a CCI-associated modifier to override the edit under appropriate circumstances, like modifier 59. But you need to provide the supportive documentation for the medically necessity of the intermediate repair.

Hope this helps!

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