Reporting excision of soft tissue tumor codes

In December 2007, the American Medical Association Current Procedural Terminology (CPT*) Editorial Panel Soft Tissue Tumor Workgroup finalized a consensus proposal related to reporting excision of soft tissue tumors. This effort resulted in extensive changes in the CPT 2010 Musculoskeletal System subsection, including 41 new codes, 53 revised codes, 7 deleted codes, and extensive guidelines to allow for more granular reporting of soft tissue tumor excision. More than 10 years later, however, questions continue to arise about appropriate code selection and separately reportable services. This column responds to these questions and offers clarity to coding confusion for this set of codes.

Are all soft tissue tumor excision codes located in one subsection of the CPT codebook?

No. The codes are scattered throughout the musculoskeletal system subsection, with listings under each anatomical excision subsection. For example, code 22902, Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm, can be found in the musculoskeletal system subsection for abdomen-excision. See Table 1 for a list of all codes and their respective 2021 Medicare Physician Fee Schedule relative value units (RVUs).

Are the code descriptors standardized?

Yes, for each anatomic family of codes, two codes are available to report excision of subcutaneous soft tissue tumors, two codes for the excision of subfascial soft tissue tumors, and two codes for the radical resection of soft tissue tumors. Each pair of codes is differentiated by the tumor size. Definitions in the musculoskeletal system introductory guidelines describe excision of each type of tumor:

Excision of subcutaneous soft connective tissue tumors involves the simple or marginal resection of tumors confined to subcutaneous tissue below the skin but above the deep fascia. These tumors are usually benign and are resected without removing a significant amount of surrounding normal tissue.

Excision of fascial or subfascial soft tissue tumors involves the resection of tumors confined to the tissue within or below the deep fascia but not involving the bone. These tumors are usually benign, are often intramuscular, and are resected without removing a significant amount of surrounding normal tissue.

Radical resection of soft connective tissue tumors involves the resection of the tumor with wide margins of normal tissue. Although these tumors may be confined to a specific layer (for example, subcutaneous, subfascial), radical resection may involve removal of tissue from one or more layers.

How do I select the correct code to report?

Code selection is based on the location and size of the tumor. Tumor size is determined by measuring the greatest diameter of the tumor plus that margin required for complete excision of the tumor. The margins refer to the most narrow margin required to adequately excise the tumor based on the physician’s judgment. The measurement of the tumor plus margin is made at the time of the excision.

TABLE 1. CPT SOFT TISSUE TUMOR EXCISION CODES

What work is inherent to the procedures and not separately reportable?

All codes include simple or intermediate repair. Dissection or elevation of tissue planes to permit resection of the tumor is included in the excision and not separately reported. Extensive undermining or other techniques to close a defect created by skin excision may require a complex repair, which may be reported separately if all the requirements for reporting complex repair are performed. Appreciable vessel exploration and/or neuroplasty may also be reported separately when performed. In addition, adjacent tissue transfer, flaps, and grafts may be reported separately when all the technical aspects of these closure procedures have been performed.

Is any special consideration given for excision of soft tissue tumors of the digits (fingers and toes)?

Digital (for example, fingers and toes) subfascial tumors are defined as those tumors involving the tendons, tendon sheaths, or joints of the digit. Tumors that simply abut but do not breach the tendon, tendon sheath, or joint capsule are considered subcutaneous soft tissue tumors.

What is the difference between excision of subcutaneous/subfascial tumors and radical resection of soft connective tissue tumors?

Radical resection of soft connective tissue tumors involves the resection of the tumor with wide margins of normal tissue. Although these tumors may be confined to a specific layer (for example, subcutaneous or subfascial), radical resection may involve removal of tissue from one or more layers. Radical resection of soft tissue tumors is most commonly used for malignant connective tissue tumors or very aggressive benign connective tissue tumors.

Is it appropriate to report the excision of soft tissue codes in the musculoskeletal system subsection for lesions or tumors that are cutaneous in origin?

No. CPT coding guidelines are clear that excision of benign lesions of cutaneous origin, such as a sebaceous cyst, should be reported using codes 11400–11446 and radical resection of malignant tumors of cutaneous origin (for example, melanoma that requires excision of the underlying soft tissue) should be reported with codes 11600–11646.

What resources does the ACS offer to improve my coding skills?

The ACS collaborates with KarenZupko & Associates (KZA) to offer on-demand and in-person coding courses that provide the tools necessary to increase revenue and decrease compliance risk. These courses are an opportunity to sharpen your coding skills. You also will be provided online access to the KZA alumni site, where you will find additional resources and frequently asked questions about correct coding. Additional information about the 2021 courses and registration can be accessed here.

*All specific references to CPT codes and descriptions are © 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.