How To Use CPT Code 21552

CPT code 21552 describes the excision of a soft tissue tumor in the neck or anterior thorax that is subcutaneous and measures 3 cm or greater. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 21552?

CPT 21552 is used to describe the excision of a soft tissue tumor in the neck or anterior thorax that is subcutaneous and measures 3 cm or greater. This code is specifically for the removal of abnormal growths or masses that are suspected to be medically significant and require further analysis and diagnosis.

2. Official Description

The official description of CPT code 21552 is: ‘Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous 3 cm or greater.’

3. Procedure

During the procedure for CPT 21552, the patient is appropriately prepped and anesthetized. The provider makes an oblique incision through the skin and subcutaneous tissue above the tumor. The mass is then freed by dissecting along its capsule and removed. The area is irrigated, checked for bleeding, and the incision is closed in layers.

4. Qualifying circumstances

CPT 21552 is used for the excision of soft tissue tumors in the neck or anterior thorax that are subcutaneous and measure 3 cm or greater. These tumors may be suspected to be medically significant and require further analysis and diagnosis. It is important to note that this code is not used for the excision of benign lesions of cutaneous origin, such as sebaceous cysts, which have their own specific codes (11420-11426).

5. When to use CPT code 21552

CPT code 21552 should be used when a provider is performing the excision of a soft tissue tumor in the neck or anterior thorax that is subcutaneous and measures 3 cm or greater. It is important to ensure that the tumor meets the size criteria and is located in the specified anatomical areas before using this code.

6. Documentation requirements

To support a claim for CPT 21552, the provider must document the following information:

• Patient’s diagnosis and the medical necessity for the excision
• Size and location of the tumor
• Details of the procedure, including the incision, dissection, and closure
• Any complications or additional procedures performed
• Pathology report, if available
• Signature of the provider

7. Billing guidelines

When billing for CPT 21552, ensure that the excision meets the specific criteria outlined in the code description. It is important to accurately document the size and location of the tumor, as well as any additional procedures or complications. CPT code 21552 should not be reported for the excision of benign lesions of cutaneous origin, as they have their own specific codes (11420-11426).

8. Historical information

CPT 21552 was added to the Current Procedural Terminology system on January 1, 2010. There have been no updates to the code since its addition.

9. Similar codes to CPT 21552

There are several similar codes to CPT 21552 that are used for excision procedures on the neck and thorax. These include:

• CPT 21550: Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm
• CPT 21551: Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm
• CPT 21553: Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater
• CPT 21554: Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater
• CPT 21555: Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater

9. Examples

1. A provider performs the excision of a 4 cm subcutaneous soft tissue tumor in the neck.
2. A patient undergoes the excision of a 6 cm subcutaneous soft tissue tumor in the anterior thorax.
3. A provider removes a 3.5 cm subcutaneous soft tissue tumor in the neck.
4. A patient requires the excision of a 5 cm subcutaneous soft tissue tumor in the anterior thorax.
5. A provider performs the excision of a 7 cm subcutaneous soft tissue tumor in the neck.
6. A patient undergoes the excision of a 4.5 cm subcutaneous soft tissue tumor in the anterior thorax.
7. A provider removes a 3.2 cm subcutaneous soft tissue tumor in the neck.
8. A patient requires the excision of a 5.8 cm subcutaneous soft tissue tumor in the anterior thorax.
9. A provider performs the excision of a 6.5 cm subcutaneous soft tissue tumor in the neck.
10. A patient undergoes the excision of a 4.7 cm subcutaneous soft tissue tumor in the anterior thorax.