How To Use CPT Code 21930

CPT 21930 refers to the excision of a subcutaneous tumor in the soft tissue of the back or flank, measuring less than 3 cm. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 21930.

1. What is CPT 21930?

CPT 21930 is a medical procedure code used to describe the excision of a subcutaneous tumor in the soft tissue of the back or flank, measuring less than 3 cm in size. This code is utilized by medical professionals to accurately document and bill for the specific services provided during the removal of such tumors.

2. 21930 CPT code description

The official description of CPT code 21930 is: “Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm.”

3. Procedure

The 21930 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. The provider makes an incision through the skin and subcutaneous tissue over the mass.
  3. The tumor is excised, along with a margin of tissue surrounding it to ensure complete removal of the lesion.
  4. The specimen is submitted for analysis to determine the presence of abnormal cells, especially cancerous cells.
  5. The wound is irrigated and closed in layers.

4. Qualifying circumstances

Patients eligible to receive CPT code 21930 services are those with a subcutaneous tumor in the soft tissue of the back or flank, measuring less than 3 cm in size. The tumor must be located below the skin and require surgical removal for diagnostic or therapeutic purposes. The patient’s medical history, physical examination, and imaging studies should support the need for this procedure.

5. When to use CPT code 21930

It is appropriate to bill the 21930 CPT code when a qualified healthcare provider performs the excision of a subcutaneous tumor in the soft tissue of the back or flank, measuring less than 3 cm in size. The procedure should be medically necessary and supported by the patient’s clinical presentation, diagnostic findings, and treatment plan.

6. Documentation requirements

To support a claim for CPT 21930, the following information should be documented in the patient’s medical record:

  • Patient’s demographic information and relevant medical history.
  • Physical examination findings, including the location, size, and characteristics of the tumor.
  • Imaging studies or other diagnostic tests supporting the need for tumor excision.
  • Details of the surgical procedure, including anesthesia, incision, excision, and closure.
  • Pathology report of the excised specimen, confirming the presence or absence of abnormal cells.
  • Postoperative care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 21930, it is essential to follow the specific guidelines and rules set forth by the payer. These may include:

  • Obtaining prior authorization, if required by the payer.
  • Ensuring accurate and complete documentation to support the medical necessity of the procedure.
  • Using appropriate modifiers, if necessary, to indicate any special circumstances related to the procedure.
  • Submitting claims in a timely manner and adhering to payer-specific deadlines.

8. Historical information

CPT 21930 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2010, with the previous descriptor being “Excision, tumor, soft tissue of back or flank.”

9. Similar codes to CPT 21930

Five similar codes to CPT 21930 and how they differentiate are:

  1. CPT 21931: This code is used for the excision of a subcutaneous tumor in the soft tissue of the back or flank, measuring 3 cm or greater in size.
  2. CPT 21932: This code refers to the excision of a deep tumor in the soft tissue of the back or flank, measuring less than 5 cm in size.
  3. CPT 21933: This code is used for the excision of a deep tumor in the soft tissue of the back or flank, measuring 5 cm or greater in size.
  4. CPT 21935: This code describes the excision of a tumor in the soft tissue of the back or flank, involving the removal of the rib.
  5. CPT 21936: This code refers to the excision of a tumor in the soft tissue of the back or flank, involving the removal of multiple ribs.

10. Examples

Here are 10 detailed examples of CPT code 21930 procedures:

  1. A 45-year-old patient with a 2 cm subcutaneous lipoma on the lower back undergoes excision under local anesthesia.
  2. A 30-year-old patient with a 1.5 cm subcutaneous cyst on the left flank undergoes excision under local anesthesia.
  3. A 55-year-old patient with a 2.5 cm subcutaneous neurofibroma on the right flank undergoes excision under local anesthesia.
  4. A 60-year-old patient with a 1 cm subcutaneous dermatofibroma on the upper back undergoes excision under local anesthesia.
  5. A 50-year-old patient with a 2.8 cm subcutaneous pilomatricoma on the left flank undergoes excision under local anesthesia.
  6. A 40-year-old patient with a 1.2 cm subcutaneous epidermoid cyst on the lower back undergoes excision under local anesthesia.
  7. A 35-year-old patient with a 2.2 cm subcutaneous sebaceous cyst on the right flank undergoes excision under local anesthesia.
  8. A 65-year-old patient with a 2.9 cm subcutaneous liposarcoma on the upper back undergoes excision under local anesthesia.
  9. A 70-year-old patient with a 1.8 cm subcutaneous angiolipoma on the left flank undergoes excision under local anesthesia.
  10. A 25-year-old patient with a 2.1 cm subcutaneous hemangioma on the right flank undergoes excision under local anesthesia.

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