How To Use CPT Code 21931

CPT 21931 describes the excision of a tumor or abnormal mass from the soft tissue below the skin in the back or flank that is 3 cm or greater in size. 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 21931?

CPT 21931 is used to describe the excision of a tumor or abnormal mass from the soft tissue below the skin in the back or flank that is 3 cm or greater in size. This code is specifically for the removal of tumors or masses that are located in the subcutaneous layer, which is the layer of tissue just below the skin.

2. Official Description

The official description of CPT code 21931 is: ‘Excision, tumor, soft tissue of back or flank, subcutaneous 3 cm or greater.’

3. Procedure

When performing CPT 21931, the healthcare provider begins by preparing the patient and administering anesthesia. Once the patient is ready, the provider makes an incision through the skin and subcutaneous tissue over the tumor or mass. The provider then carefully excises the tumor, ensuring that a margin of surrounding tissue is also removed to ensure complete removal of the lesion. The excised specimen is then sent for analysis to determine the presence of abnormal cells, particularly cancerous cells. After excision, the provider irrigates the wound and closes the incision in layers.

4. Qualifying circumstances

CPT 21931 is used for the excision of tumors or abnormal masses that are located in the soft tissue below the skin in the back or flank. The size of the tumor or mass must be 3 cm or greater. It is important to note that this code is specifically for the excision of tumors or masses in the subcutaneous layer and does not apply to benign lesions of cutaneous origin, such as sebaceous cysts, which have their own specific codes (11400-11406).

5. When to use CPT code 21931

CPT code 21931 should be used when a healthcare provider performs the excision of a tumor or abnormal mass that is located in the soft tissue below the skin in the back or flank and is 3 cm or greater in size. It is important to accurately measure the size of the tumor or mass to determine if it meets the criteria for this code. If the tumor or mass is smaller than 3 cm, a different code should be used.

6. Documentation requirements

To support a claim for CPT 21931, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for excision of the tumor or mass
• Size of the tumor or mass
• Location of the tumor or mass (back or flank)
• Date of the procedure
• Details of the procedure, including the incision, excision, and closure
• Submission of the excised specimen for analysis
• Any additional relevant information or complications

7. Billing guidelines

When billing for CPT 21931, ensure that the excision is performed on a tumor or abnormal mass that is located in the soft tissue of the back or flank and is 3 cm or greater in size. It is important to accurately measure the size of the tumor or mass to determine if it meets the criteria for this code. Additionally, it is important to note that CPT 21931 is not appropriate for the excision of benign lesions of cutaneous origin, such as sebaceous cysts, which have their own specific codes (11400-11406).

8. Historical information

CPT 21931 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 21931

Five similar codes to CPT 21931 include:

• CPT 21930: Excision, tumor, soft tissue of back or flank, subcutaneous, less than 3 cm
• CPT 21932: Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater
• CPT 21933: Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); less than 5 cm
• CPT 21935: Excision, tumor, soft tissue of back or flank, deep subfascial (eg, intramuscular); 5 cm or greater
• CPT 21936: Excision, tumor, soft tissue of back or flank, deep subfascial (eg, intramuscular); less than 5 cm

9. Examples

1. A healthcare provider performs the excision of a 4 cm tumor located in the soft tissue of the back.
2. A patient undergoes the excision of a 5 cm abnormal mass in the subcutaneous tissue of the flank.
3. A provider removes a 6 cm tumor from the soft tissue of the back, ensuring complete excision with a margin of surrounding tissue.
4. An individual undergoes the excision of a 3 cm abnormal mass in the subcutaneous tissue of the flank.
5. A healthcare provider performs the excision of a 7 cm tumor located in the soft tissue of the back.
6. A patient undergoes the excision of a 4 cm abnormal mass in the subcutaneous tissue of the flank.
7. A provider removes a 5 cm tumor from the soft tissue of the back, ensuring complete excision with a margin of surrounding tissue.
8. An individual undergoes the excision of a 6 cm abnormal mass in the subcutaneous tissue of the flank.
9. A healthcare provider performs the excision of a 8 cm tumor located in the soft tissue of the back.
10. A patient undergoes the excision of a 7 cm abnormal mass in the subcutaneous tissue of the flank.