How To Use CPT Code 27040

CPT 27040 describes the procedure of performing a biopsy on the superficial soft tissue of the pelvis and hip area. 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 27040?

CPT 27040 can be used to describe the biopsy procedure performed on the superficial soft tissue of the pelvis and hip area. This code is used when the provider needs to determine whether the cells in the patient’s tissue are malignant, benign, or precancerous. The biopsy involves removing a portion or the entirety of suspicious tissue for further examination.

2. Official Description

The official description of CPT code 27040 is: ‘Biopsy, soft tissue of pelvis and hip area; superficial.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made in the skin over the subcutaneous tumor in the patient’s hip or pelvis area.
3. The provider then incises the tumor capsule and excises a sample of the tumor.
4. The excised tissue sample is sent to the laboratory for analysis.
5. If necessary, the provider may use microdissection to precisely remove the sample of tissue.
6. The wound area is irrigated, and the incision is closed by suturing the layers of tissue together.

4. Qualifying circumstances

CPT 27040 is used when the provider performs a biopsy on the superficial soft tissue of the pelvis and hip area. This may be done to determine the nature of a lesion or tumor, whether it is benign or malignant. The biopsy may be performed on subcutaneous tissue, which is below the surface of the skin but not deep within the muscle or subfascial layers.

5. When to use CPT code 27040

CPT code 27040 should be used when the provider performs a biopsy on the superficial soft tissue of the pelvis and hip area. It is important to ensure that the biopsy is performed on the superficial tissue and not on the deep, subfascial, or intramuscular tissue. If the biopsy is performed on the deep tissue, CPT code 27041 should be used instead.

6. Documentation requirements

To support a claim for CPT 27040, the provider must document the following information:

• Patient’s diagnosis or reason for performing the biopsy
• Details of the procedure, including the location of the biopsy and the type of tissue sampled
• Any additional procedures performed during the biopsy, such as microdissection
• Any complications or unexpected findings
• Signature of the provider performing the biopsy

7. Billing guidelines

When billing for CPT 27040, ensure that the biopsy is performed on the superficial soft tissue of the pelvis and hip area. If the biopsy is performed on the deep, subfascial, or intramuscular tissue, use CPT code 27041 instead. It is important to follow the specific guidelines provided by the payer and to accurately report the details of the procedure and any additional services performed.

8. Historical information

CPT 27040 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider performs a biopsy on the superficial soft tissue of the pelvis and hip area to determine whether a suspicious lump is cancerous or benign.
2. A patient presents with a mass in their hip area, and the provider performs a biopsy on the superficial soft tissue to diagnose the nature of the mass.
3. A provider performs a biopsy on the superficial soft tissue of the pelvis and hip area to investigate a lesion that has been causing the patient discomfort.
4. A patient with a history of cancer undergoes a biopsy on the superficial soft tissue of the pelvis and hip area to monitor for any recurrence or metastasis.
5. A provider performs a biopsy on the superficial soft tissue of the pelvis and hip area to determine the cause of chronic pain in a patient.
6. A patient presents with a suspicious lump in their hip area, and the provider performs a biopsy on the superficial soft tissue to rule out any malignancy.
7. A provider performs a biopsy on the superficial soft tissue of the pelvis and hip area to investigate a mass that was detected during a routine imaging study.
8. A patient with a family history of cancer undergoes a biopsy on the superficial soft tissue of the pelvis and hip area as a precautionary measure.
9. A provider performs a biopsy on the superficial soft tissue of the pelvis and hip area to determine the cause of unexplained swelling in a patient.
10. A patient presents with a suspicious lesion in their hip area, and the provider performs a biopsy on the superficial soft tissue to guide further treatment decisions.