To find the appropriate code(s), read the details to see whether the surgery involves excision with simple, layer, or complex closure, or a more complex closure accomplished with a tissue transfer or rearrangement. Then, code the preauricular cyst claim using these rules:
Excision: For preauricular cysts that involve simple closure, use the excision benign lesions of face codes (11440-11446).
Complex closure: If the surgeon uses a layer (12041-12057) or complex closure (13131-+13133), code both the closure and the benign lesion excision, and report the procedure with more relative value units (RVUs) first.
More complex closure: If the closure is some type of tissue transfer, then code the closure [14040-14041. The flap includes the excision. So, you do not code the cyst’s excision.
Report a local rotation tissue flap, with 14040 (Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; defect 10 sq cm or less) or 14041 (…defect 10.1 sq cm to 30.0 sq cm) depending on the defect’s size.
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If the surgeon does not mention the defect’s size, you can only use 14040.
The procedure occurs in a previously operated field that may make the work involved substantially greater than 14040 or 14041 usually requires. Therefore, the transfer could qualify for modifier 22 (Increased procedural services), provided the documentation supports the increased service modifier. Keep in mind that 14040 is coded per defect, not per flap.