How To Use CPT Code 26118

CPT 26118 describes the extensive surgical removal of a soft tissue tumor and surrounding tissues of the hand or finger, measuring 3cm or more. 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 26118?

CPT 26118 can be used to describe the radical resection of a soft tissue tumor in the hand or finger that measures 3cm or greater. This code is used when the physician performs an extensive surgical removal of the tumor and surrounding tissues, including necessary structures, to ensure complete removal and clear margins.

2. Official Description

The official description of CPT code 26118 is: ‘Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; 3 cm or greater.’ This code is specifically for the surgical removal of soft tissue tumors in the hand or finger that are 3cm or larger in size. It does not include tumors of cutaneous origin, such as melanoma, which have their own specific codes (11620 – 11626).

3. Procedure

1. The physician makes an incision and raises medial and lateral skin flaps to access the tumor and surrounding tissues.
2. The tumor, measuring 3cm or greater, is removed en bloc, along with any necessary surrounding structures.
3. Frozen sections are taken from the surrounding tissue to ensure clear margins, and both the margins and tumor are sent to pathology for further examination.
4. If necessary, additional excision is performed to obtain a clear margin.
5. Hemostasis is achieved using bipolar electrocautery.
6. The wound is inspected, irrigated, and closed.

4. Qualifying circumstances

CPT 26118 is used for patients who require extensive surgical removal of a soft tissue tumor in the hand or finger that measures 3cm or greater. The procedure is typically performed by a physician and may involve the removal of surrounding structures to ensure complete removal and clear margins.

5. When to use CPT code 26118

CPT code 26118 should be used when the physician performs an extensive surgical removal of a soft tissue tumor in the hand or finger that measures 3cm or greater. It is important to accurately document the size of the tumor and the depth of the surgery to ensure proper coding.

6. Documentation requirements

To support a claim for CPT 26118, the physician must document the following information:

• Size of the tumor
• Depth of the surgery
• Details of the procedure, including the incision, removal of the tumor and surrounding tissues, and any additional excision performed
• Use of frozen sections and pathology examination
• Method of achieving hemostasis
• Inspection, irrigation, and closure of the wound

7. Billing guidelines

When billing for CPT 26118, ensure that the procedure meets the criteria for extensive surgical removal of a soft tissue tumor in the hand or finger that measures 3cm or greater. It is important to accurately document the size of the tumor and the depth of the surgery to support the claim. Additionally, check with the payer regarding coverage for surgical assistants, and append modifier 80 if the documentation demonstrates medical necessity for their services.

8. Historical information

CPT 26118 was added to the Current Procedural Terminology system on January 1, 2010. On January 1, 2014, the code description was updated to include the term “malignant neoplasm” in addition to “tumor.” There have been no further updates to the code since its addition.

9. Examples

1. A physician performs an extensive surgical removal of a soft tissue tumor measuring 4cm in the hand of a patient.
2. A surgeon removes a soft tissue tumor measuring 5cm in the finger of a patient, ensuring clear margins and complete removal.
3. A hand specialist performs an extensive resection of a sarcoma measuring 6cm in the hand of a patient, removing surrounding tissues as necessary.
4. A surgeon removes a soft tissue tumor measuring 3.5cm in the finger of a patient, taking frozen sections to ensure clear margins.
5. A physician performs an extensive surgical removal of a soft tissue tumor measuring 4.5cm in the hand of a patient, achieving hemostasis using bipolar electrocautery.
6. A hand surgeon removes a soft tissue tumor measuring 3.2cm in the finger of a patient, inspecting and irrigating the wound before closure.
7. A surgeon performs an extensive resection of a sarcoma measuring 7cm in the hand of a patient, obtaining clear margins through additional excision.
8. A hand specialist removes a soft tissue tumor measuring 3.8cm in the finger of a patient, sending the tumor and margins to pathology for examination.
9. A physician performs an extensive surgical removal of a soft tissue tumor measuring 4.2cm in the hand of a patient, raising medial and lateral skin flaps for access.
10. A surgeon removes a soft tissue tumor measuring 3.6cm in the finger of a patient, achieving hemostasis and closing the wound after inspection and irrigation.