CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2002 Mar;9(3):21.
Comparing excision codes
I submitted 21930 for the office removal of a 3-cm subcutaneous lipoma from a patient’s lower left back, but our coders think 11403 is more accurate. What’s the difference between 11403 and 21930?
According to CPT, there are actually a number of differences between 11403 and 21930. Code 11403 is for “excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm,” and it appears in the “surgery/integumentary system” section of the CPT manual. It is for full-thickness (through the dermis) removal of benign lesions of the skin or subcutaneous tissues (e.g., cicatricial, fibrous, inflammatory, congenital and cystic lesions), including local anesthesia and simple (nonlayered) closure. Code 21930 is for “excision, tumor, soft tissue of back or flank,” and it appears in the “surgery/musculoskeletal system” of the manual. In the Medicare Fee Schedule database, 11403 has a 10-day global period and 21930 has a 90-day global period, suggesting that 21930 is a more extensive procedure.
There is nothing in the descriptor of 21930 that would obviously preclude its use in your situation. A lipoma is a fatty tumor, and the physician did excise it from the soft tissue of the back. The only indicator that this code may not be appropriate is the 90-day global period that Medicare attaches to this procedure. Services with a 90-day global period typically represent more involved procedures that are not usually done in a physician’s office. You may want to review your service in light of the information provided above to decide which code most accurately identifies it.
Extra prenatal visits
One of my patients had a 27-week preterm delivery with her first pregnancy, so for her second pregnancy, my OB consultant recommended I see the patient weekly for cervical checks from 26 weeks to 34 weeks. What code should I submit for these extra prenatal visits that aren’t included in the global package?
You should code the extra visits using the appropriate office or other outpatient services codes (99211–99215), assuming the visits occur in the office or other outpatient setting. According to CPT, antepartum care includes “monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation and weekly visits until delivery” and “any other visits or services within this time period should be coded separately.”
When coding the separate E/M visit outside of the global package, be sure to submit an ICD-9 code that reflects the reason for the encounter and indicates why the extra visits are medically necessary. For example, if the patient is seen for a urinary tract infection, the appropriate ICD-9 code (e.g., 646.63, “Infections of genitourinary tract in pregnancy, antepartum condition or complication”) would be used as the primary diagnosis and not the typical diagnosis “V” code (e.g., V22.1, “Supervision of other normal pregnancy”).
Coding flexible sigmoidoscopy
What code(s) should I submit for flexible sigmoidoscopy?
There are actually 11 different CPT codes for flexible sigmoidoscopy, ranging from 45330, “Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure),” to 45345, “Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation).” CPT defines sigmoidoscopy as “the examination of the entire rectum, sigmoid colon and may include examination of a portion of the descending colon.” From a CPT perspective, surgical endoscopy always includes diagnostic endoscopy, so if you do flexible sigmoidoscopy with biopsy, you would only submit 45331, “Sigmoidoscopy, flexible; with biopsy, single or multiple,” since 45330 would be included in this procedure. Note that when flexible sigmoidoscopy is done to screen for colorectal cancer, Medicare requires the use of HCPCS code G0104.
Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to Family Practice Management.
Conflicts of interest: none reported.
These questions and answers were reviewed by members of the FPM Coding & Documentation Review Panel, which includes: Robert H. Bosl, MD, FAAFP; Thomas A. Felger, MD, ABFP, CMCM; David Filipi, MD, MBA, and the Coding and Compliance Department of Physicians Clinic; Lynn Handy, CPC, LPN; Emily Hill, PA-C; Joy Newby, LPN, CPC; and P. Lynn Sallings, CPC.
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Editor’s note: While this department represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will accept the coding and documentation recommended. Because CPT and ICD-9 codes change annually, you should refer to the current CPT and ICD-9 manuals and the “Documentation Guidelines for Evaluation and Management Services” for the most detailed and up-to-date information.
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