Patient was registered for ambulatory surgery. Excision of recurrent ganglion cyst, dorsum of the right wrist, was performed. Diagnosis: ganglion, right wrist. Which ICD-10-CM code is reported as the first-listed diagnosis? Which CPT code is reported as the first-listed procedure?
The correct answer and explanation is:
ICD-10-CM Code (First-Listed Diagnosis):
M67.431 – Ganglion, right wrist
CPT Code (First-Listed Procedure):
25111 – Excision of ganglion cyst; tendon sheath or capsule
Explanation
The ICD-10-CM code is used to classify and report the diagnosis. Since the patient was diagnosed with a ganglion cyst on the right wrist, the code M67.431 applies. This code specifically identifies a ganglion cyst located on the right wrist, which matches the documented diagnosis in the medical record. Accurate coding is essential for medical billing, epidemiological tracking, and treatment planning.
For the procedure, CPT codes are used to describe the medical, surgical, and diagnostic services provided. The patient underwent an ambulatory surgery to excise a recurrent ganglion cyst on the dorsum of the right wrist. The appropriate CPT code for this procedure is 25111. This code is specifically for excision of a ganglion cyst from a tendon sheath or joint capsule, which is exactly what the surgery involved. The code does not differentiate between initial or recurrent cysts; it covers excision regardless of recurrence.
Selecting the correct first-listed diagnosis and procedure codes is crucial for proper billing and insurance claims. The first-listed diagnosis reflects the main reason for the encounter, which is the ganglion cyst in this case. The first-listed procedure code is the primary surgical intervention performed, which here is the excision of the cyst. Documentation must support the codes chosen, including diagnosis location and procedure details.
In summary, M67.431 captures the diagnosis of a ganglion cyst on the right wrist, and 25111 accurately represents the surgical excision of the cyst. Both codes are widely recognized and standardized to ensure consistency in medical records and claims processing.