Integumentary System & Breast Procedures CPT Coding Notes

Nails CPT Coding

• CPT code range: 11719-11765
• Use HCPCS Level II finger (F) and toe (T) modifiers.

Coding Examples:

• Partial avulsion of the nail plate of the left middle finger:
  • CPT code: 11730-F2
• Avulsion of nail bed of left great toe and left second toe:
  • CPT codes: 11730-TA, 11732-T1
• Complete excision of nail and matrix, right great toe:
  • CPT code: 11750-T5

Pilonidal Cyst CPT Coding

• CPT code range (excision): 11770-11772
• CPT code range (I&D): 10080-10081
• Definition: A pilonidal cyst or sinus is entrapped epithelial tissue located in the sacrococcygeal area above the buttocks, usually associated with ingrown hair. A sinus cavity is present and may have a fluid-producing cystic lining.

Coding Examples:

• Excision of extensive pilonidal sinus superficial to the fascia overlying the sacrum but with subcutaneous extensions; wound left open to heal by granulation:
  • CPT code: 11771
• Incision and drainage of pilonidal cyst near the tailbone and cleft of the buttocks; loose packing placed, wound left open:
  • CPT code: 10080

Destruction of Skin Lesions

• Benign examples: condylomata, papillomata, milia, plantar warts
• Premalignant example: Actinic Keratoses (AK)
• Malignant examples: melanoma, squamous cell carcinoma, basal cell carcinoma

Coding for Destruction:

Benign or Premalignant Lesions

• CPT Code Range: 17000-17004, 17110-17250
• Codes 17106-17108 are excluded from this range
• Necessary Documentation:
  • Diagnosis of benign or premalignant skin lesion
  • Lesion removed by a method such as electrosurgery, cryosurgery, laser, or chemical treatment
  • Number of lesions removed

Malignant Lesions

• CPT Code Range: 17260-17286
• Necessary Documentation:
  • Diagnosis of malignant skin lesion
  • Lesion removed by destruction
  • Diameter of lesion
  • Location of lesion

Coding Examples:

• Two malignant skin lesions on the right foot measuring 1.1 cm and 2.0 cm, and one malignant lesion on the neck measuring 2.9 cm were destroyed. Electrocautery was used for the first two lesions and laser was used for the third lesion.
  • CPT codes: 17273, 17272-51, 17272-51
  • Modifier 51 is appended to indicate multiple procedures were performed.
  • Sequence the code for destruction of the largest lesion first.
  • We do not use laterality modifiers (RT and LT) for procedures on the skin.

Breast Procedures

Coding Examples:

• 32-year-old female undergoes breast lift and augmentation mammaplasty, both breasts, with saline implants.
  • CPT codes: 19316-50, 19325-50
  • 19316: Mastopexy (breast lift)
  • 19325: Augmentation with Implant
• Patient underwent a right mastectomy for breast cancer five months ago. She presents today for delayed breast reconstruction and the surgeon performs insertion of saline-filled breast prosthesis.
  • CPT code: 19342-RT
  • 19342: Breast, Implant, Insertion
• With the use of magnetic resonance guidance, the surgeon placed a metallic clip to identify the suspicious tissue In the right breast. A percutaneous needle biopsy was performed.
  • CPT code: 19085-RT
  • 19085: Breast, Biopsy, with Localization Device Placement, Magnetic Resonance Guided