march 2010

HAND/FINGER TUMOR CODING

In 2010 coder’s were presented with new challenges when CPT added “out of sequence codes” and the tumor excision codes which are based on the size and location of the tumor. There are some instructions in the CPT manual to assist you in selecting the correct code so let’s review them.

Tumor location is defined as either subcutaneous or subfascial.

• Subcutaneous tumors are confined to the subcutaneous tissue below the level of the dermis but above the fascia.
• Fascial or subfascial tumors are confined to the tissue within or below the fascia, but not involving bone.

Once the location has been determined, calculate the size of the tumor. This is done in the same manner as calculating a lesion size - that is, by using the greatest diameter of the tumor and the most narrow margins necessary for excision.

For digital tumors of the fingers, subfascial is defined as those tumors involving the tendons, tendon sheaths or joints of a digit. Tumors which simply abut but do not breach the tendon, tendon sheath, or joint capsule are considered subcutaneous soft tissue tumors.

Sarcoma, fibroma, lipoma and giant cell are different types of tumors – cysts and ganglions are not classified as tumors therefore, if you have a cyst or ganglion of the tendon sheath or joint capsule use the existing CPT code 26160–-Excision of lesion of tendon sheath or joint capsule (eg, cyst or ganglion) and not a tumor excision code.

Services that can be additionally reported:

• “Appreciable” vessel exploration and/or neuroplasty
• Complex repair, flaps and grafts (simple and intermediate repairs are included in the CPT codes)