How To Use CPT Code 22904

CPT code 22904 describes the radical resection of a soft tissue malignant tumor, such as a sarcoma, from the abdominal wall. 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 22904?

CPT 22904 is used to describe the radical resection of a soft tissue malignant tumor, specifically from the abdominal wall. This procedure involves the extensive removal of the tumor, not limited to its dimensions, but expanding to the surrounding area and anatomical structures suspected for involvement. The diameter of the tumor and the required margins measure less than 5 cm.

2. Official Description

The official description of CPT code 22904 is: ‘Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall less than 5 cm.’

3. Procedure

The procedure for CPT code 22904 involves the following steps:

1. After administering proper anesthesia and preparing the operative site, a curvilinear incision is made around the tumor site, typically following the skin creases.
2. The incision is extended deep and around the tumor, allowing for adequate exposure of the underlying anatomy.
3. Fascial, subfascial, and/or muscle flaps may be raised to further expose the area.
4. Neurovascular structures in the area are identified and preserved.
5. Once the tumor is well localized, a sharp scalpel is used to dissect the tumor from the surrounding tissue margin, and the tumor is removed.
6. To rule out further malignancy, an additional surrounding wide area of margin is also dissected and removed.
7. After satisfactory radical removal of the tumor and appropriate surrounding margin from the abdominal wall, the incision is repaired in a layered fashion.

A total excision diameter of less than 5 cm is reportable with this code.

4. Qualifying circumstances

CPT 22904 is performed on patients with soft tissue malignant tumors, such as sarcomas, located in the abdominal wall. The procedure requires the removal of the tumor along with wide margins of surrounding tissue. It is important to note that the diameter of the tumor and the margins required must measure less than 5 cm.

5. When to use CPT code 22904

CPT code 22904 should be used when a radical resection of a soft tissue malignant tumor from the abdominal wall is performed, with the tumor diameter and required margins measuring less than 5 cm. This code should not be used for tumors located in other areas of the body or if the tumor dimensions exceed the specified criteria.

6. Documentation requirements

To support a claim for CPT 22904, the following documentation is required:

• Patient’s diagnosis of a soft tissue malignant tumor in the abdominal wall
• Description of the tumor’s dimensions and margins required for resection
• Date of the procedure
• Details of the surgical approach, including the incision site and any additional flaps raised
• Documentation of the tumor removal and surrounding margin dissection
• Method of incision closure

7. Billing guidelines

When billing for CPT 22904, ensure that the procedure performed meets the criteria specified in the code description. It is important to document the tumor dimensions and required margins accurately. CPT code 22904 should not be reported if the tumor dimensions exceed the specified criteria or if the procedure is performed on tumors in other areas of the body.

8. Historical information

CPT 22904 was added to the Current Procedural Terminology system on January 1, 2010. On January 1, 2014, the code description was changed to specify ‘malignant neoplasm’ instead of ‘tumor’ in the code description.

9. Similar codes to CPT 22904

There are several similar codes to CPT 22904 that involve the excision of soft tissue tumors. These include:

• CPT 22900: Excision, soft tissue tumor, subcutaneous tissue
• CPT 22901: Excision, soft tissue tumor, subfascial (eg, intramuscular)
• CPT 22902: Excision, soft tissue tumor, subfascial (eg, intramuscular), deep
• CPT 22903: Excision, soft tissue tumor, subfascial (eg, intramuscular), deep, extensive
• CPT 22905: Excision, soft tissue tumor, other than subcutaneous or subfascial (eg, intramuscular); less than 5 cm

9. Examples

1. A surgeon performs a radical resection of a 4 cm soft tissue sarcoma from the abdominal wall.
2. A patient undergoes a radical resection of a 3 cm malignant tumor from the abdominal wall, with wide margins of surrounding tissue.
3. A soft tissue sarcoma measuring 2 cm is completely excised from the abdominal wall, along with the required margins.
4. A surgeon performs a radical resection of a 4 cm malignant tumor from the abdominal wall, ensuring wide margins of surrounding tissue are removed.
5. A patient undergoes a radical resection of a 5 cm soft tissue sarcoma from the abdominal wall, exceeding the specified criteria for CPT 22904.
6. A soft tissue malignant tumor measuring 3 cm is excised from the abdominal wall, but the required margins are not removed, making CPT 22904 inappropriate for billing.
7. A surgeon performs a radical resection of a 4 cm soft tissue sarcoma from the thigh, not meeting the criteria for CPT 22904.
8. A patient undergoes a radical resection of a 3 cm malignant tumor from the arm, not meeting the criteria for CPT 22904.
9. A soft tissue sarcoma measuring 2 cm is completely excised from the back, not meeting the criteria for CPT 22904.
10. A surgeon performs a radical resection of a 4 cm malignant tumor from the chest, not meeting the criteria for CPT 22904.