A patient with a history of gastroschisis with silo repair subsequently developed periumbilical swelling and tenderness which appeared to be a hernia. A decision was made to perform a hernia repair. An incision was made with dissection through the dermis. The skin was raised under a skin tag in the lower left corner of the umbilicus. Underneath the skin tag was herniated fat. The 0.5 cm herniated fat defect was excised noting the underlying fascia was intact. Rather than a hernia, it was discovered that there was periumbilical scar tissue. The surrounding scar tissue was lysed and the inner margin of the initial incision was excised incorporating the skin tag. How is this umbilicoplasty coded? Is the unlisted integumentary CPT code 17999, correct when the dissection goes below the skin level?
Assign CPT code 11400, Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less, for the removal of the periumbilical scar tissue with underlying fat. Excision of subcutaneous fat is included in the integumentary system CPT codes.
CPT guidance as published in CPT Assistant, November 2019, page 3, advises that scar revision is reported with codes from the excision of benign lesion subsection (11400-11471) after scar revisions were removed from the complex repair guidelines. Although the code narrative states this code is not appropriate for skin tag removal, the removal of the skin tag was not the intent of this procedure. The intent of the procedure was to remove the scar tissue with underlying subcutaneous fat. The removal of the skin tag would be inherent to the excision of the scar tissue.