Pilonidal Cyst Excision, Skin Injections and Implants: 11770–11983

Part 1 of 4

Excision of a pilonidal cyst: 11770–11772

A pilonidal cyst is a cyst or sinus near the tailbone, at the top of the buttock crease, that often holds hair and skin debris. Draining it is incision and drainage (10080, 10081; see Incision & Drainage). Removing it is an excision, coded here.

Picture it · the closure tells you which code

Simple: one layer

11770

Superficial cyst. The hole is closed with one layer of stitches.

Extensive: several layers

11771

Deeper cyst, can reach the fascia. Closed in several layers.

Complicated: needs a flap

11772

A large or deep hole is covered with a flap of nearby skin (dashed blue). Code the flap (adjacent tissue transfer) as well.

Epidermis
Dermis
Subcutaneous fat
Fascia
Muscle

All three are excisions of the cyst. The depth of the cyst and how the hole is closed decide the code.

Code	Excision	What the note shows
11770	Simple	Superficial cyst; wound closed in a single layer
11771	Extensive	Larger sinus with extensions into the subcutaneous tissue, still above the sacral fascia; closed in several layers
11772	Complicated	Many subcutaneous extensions; the large defect is closed with a flap or left open to heal by granulation

Pick one code. The closure is part of these codes, so a simple or layered closure isn't coded separately.
With 11772, code the flap or graft too. AMA's CPT Assistant addresses a complicated excision closed with a rhomboid flap: the adjacent tissue transfer isn't included in 11772 and is reported in addition.

Part 2 of 4

Intralesional injection: 11900–11901

The physician injects a drug (often a steroid) straight into skin lesions, for example a painful keloid scar.

Code	Lesions injected
11900	Up to and including 7
11901	More than 7

Choose one code by the total number of lesions in the session.

Tattooing and fillers: add the amounts, then code once

Picture it · add every area first, then code the total

Tattooing (correcting colour defects)

Measured in square centimeters

face 20

hand 10

forearm 10

40 sq cm in total

Over 6 sq cm, so start at 11921 (first 20), then +11922 for the next 20. Don't also report 11920; it is only for 6 sq cm or less.

Dermal filler (e.g. collagen)

Measured in cc (volume injected)

cheeks 4

nose 2

6 cc in total

6 cc falls in 5.1–10.0 cc, so one code: 11952. Only one filler code per session.

Several areas in one session are added together and reported from one code family.

Tattooing: 11920–11922

Tattooing here is a medical procedure: insoluble pigment is placed in the skin to correct a colour defect, such as the light patches of vitiligo, so they match the skin around them.

Code	Area
11920	6.0 sq cm or less
11921	6.1 to 20.0 sq cm
+11922	Each additional 20.0 sq cm, or part thereof

Add up all areas. 42 sq cm = 11921 (first 20) + 11922 (next 20) + 11922 (last 2) = 11921, 11922 × 2. 11920 is never reported with 11921.

Dermal fillers: 11950–11954

Collagen or another filler is injected under the skin to restore volume, for example in wrinkles. Coded by the total volume in the session:

Code	Volume
11950	1 cc or less
11951	1.1 to 5.0 cc
11952	5.1 to 10.0 cc
11954	Over 10.0 cc

Cheeks 10 cc + nose 10 cc + forehead 10 cc = 30 cc = 11954, once. Fillers are often cosmetic, so check payer coverage.

Part 3 of 4

Tissue expanders: 11960, 11970, 11971, 19357

A tissue expander is a balloon-like device placed under the skin (or muscle) and filled a little at a time to stretch the skin. It makes room for reconstruction after tumor removal, burns or trauma, and is common after a mastectomy.

Situation	Code
Insertion of tissue expander, other than breast	11960
Insertion of tissue expander for breast reconstruction	19357
Expander removed and replaced with a permanent implant	11970
Expander removed only, no implant placed	11971

The expander is temporary: weeks later, it is usually exchanged for a permanent silicone implant (11970).

Part 4 of 4

Contraceptive capsules and hormone pellets

Code	Procedure	How many times?
11976	Removal of implantable contraceptive capsules (e.g., Norplant)	Once per session
11980	Subcutaneous hormone pellet implantation	Once per session

Norplant capsules are no longer sold in the US, so there is no insertion code; patients who still have them may come in for removal. Hormone pellets dissolve and aren't removed.

Drug-delivery implants: 11981–11983

Picture it · a drug-delivery implant

11981

Insert

11982

Remove

11983

Remove and put in a new one

Brand names you may see: Nexplanon or Implanon (contraceptive rods), and ready-made antibiotic beads.

These codes cover a ready-made drug-delivery implant: for example a contraceptive rod (Nexplanon, Implanon) in the upper arm, or prefabricated antibiotic beads (such as Stimulan) placed during an orthopedic procedure to prevent or treat infection.

Code	Procedure
11981	Insertion of drug-delivery implant
11982	Removal of non-biodegradable drug-delivery implant
11983	Removal with reinsertion of non-biodegradable drug-delivery implant

End of the chapter: check what you remember

Simple vs. extensive vs. complicated pilonidal cyst excision
Injections by lesion count, tattooing by sq cm, fillers by cc
Tissue expanders: breast vs. other sites, replacement and removal
Drug-delivery implants: insert, remove, replace, and when 20700 applies instead

Take the integumentary test12 questions on integumentary procedures