By rob eagar 
Pilonidal cyst is a painful condition. Its awkward location between the clefts of the buttocks can cause it to hinder day to day tasks. Also, if the condition turns chronic due to frequent recurrence, pilonidal cyst excision is the only way forward. For colorectal surgeons offering treatment for hard-to-treat pilonidal cysts accurate medical coding is essential. Cost of procedure, billing, and reimbursement; all depends on proper documentation. Listed below is the relevant coding practice in pilonidal cyst treatment:
Diagnosis Of Pilonidal Cyst
A type of a pimple grows at the end of the tailbone when one is affected by pilonidal cyst. It has a painless and benign start in a hair follicle. The cyst gradually grows in size and accumulates skin debris and pus build-up. This makes the area red, tender, and painful. The diagnosis of a pilonidal cyst is based on physical examination and symptom acuity. In chronic cases or if the patient experiences debilitating symptoms, scans and imaging may be required to determine the extent of infective tissue.
When Is Excision Of Pilonidal Cyst Indicated?
The treatment for a pilonidal cyst passes through various stages. From self-healing and home remedies to non-invasive and pilonidal cyst excision surgery; one can heal from a cyst in several ways. But the surgical removal of the cyst becomes indicated if one or more of the symptoms persist. These include:
- Recurrent Infection – The recurrence rate of a pilonidal cyst is high. It also depends on the type of surgical removal. Almost 40% cases come back after incision and drainage and 32% cysts resurface after surgical removal.
- Persistent Pain or Drainage – If the symptoms of the disease are severe and interfere with the day-to-day operations.
- Complex Cysts – If the size of the cyst is big and area of infection is large, a pilonidal cyst excision surgery can help effectively remove the affected tissue.
- No Relief From Conventional Treatments – Use of antibiotics is mandatory to eliminate infection. Also sitz baths and warm compress promise effective relief from painful symptoms. But if the patient shows signs of recurrence of cyst, the surgeon will definitely recommend a surgical removal.
Preparing For The Surgery
The initial assessment and consultation will help the surgeon decide the type of surgery required for excision pilonidal cyst. After physical evaluation, the patient is apprised about the possible treatment method and its risks and benefits. The post-surgery care for every method is also highlighted to ensure proper and quick healing. Depending on the type of surgical technique advised, that ranges from non-invasive to extensive excision for complex cases, the coding for the procedure is done accordingly.
Commonly Used Codes For Pilonidal Cyst Surgery
In order to maintain uniformity in the entire process of treating pilonidal cyst, the surgeon will follow the Current Procedural Terminology (CPT) codes. These codes are issued by the American Medical Association.Some codes that are used in routine are:
- CPT Code 11770 – If the excision of the pilonidal cyst is simple and apparently uncomplicated, it is coded under the said code.
- CPT Code 11771 – This code is used for procedures involved in extensive pilonidal cyst or sinus removal.
- CPT Code 11772 – The colorectal surgeon will use this code if the pilonidal cyst is large and affects the surrounding area and has extensive tissue involvement. The procedure marks removal of complicated pilonidal cyst or sinus with significant infection and multiple sinuses.
- CPT Code 10080 – This is a code used to mark pilonidal cyst cases that require incision and drainage. The specific code is for simple cases of incision.
- CPT Code 10081 – For more complex and complicated cases of incision and drainage of pilonidal cyst, code 10081 is used for uniformity.
Importance Of Correct Coding
One of the most important questions apart from ‘what do we make out of these codes’ is ‘why do we need these codes’. Codes not just bring about uniformity, but are important for several reasons. These are mentioned below:
Accurate Billing and Reimbursement
Every medical procedure has a cost involved. If you want to seek health insurance cover, the reimbursement is possible only if the billing is correct. Accurate and precise coding help in faster processing of refund applications.
Regulatory Compliance
Medical coding is governed by strict regulations and guidelines. Non-compliance can result in legal consequences and failure to comply with this requirement can attract heavy penalties. Repeated failure will lead to loss of license for the medical facility.
Record Keeping
Proper and accurate coding is an essential requirement for proper maintenance of patient records. This information is useful for public health planning and policy-making.
Patient Care
Proper coding is important for patient care. It is useful in maintaining accurate and comprehensive patient records. As the recurrence rate of pilonidal cyst is high, a complete medical history allows doctors to make informed decisions about subsequent treatment. This is important for improving patient outcomes.
Final Thoughts
The pilonidal cyst must not be left untreated. A consultation with an experienced colorectal surgeon like Dr. Allen Kamrava MD MBA will help you figure out the best treatment for the condition. The healthcare facility is not only rated for its top-quality services and best patient care but also marked for its compliance with regulatory norms. By carefully following the pilonidal cyst excision codes it ensures complete compliance with coding standards for medical purposes.