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CPC STUDY COURSE · 2026 EDITION

Excision of a symptomatic epidermal cyst

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-08 · Professional outpatient claim; Original Medicare unless stated otherwise

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Reason and final diagnosis

Fictional patient Leon Park, age 46, attends a previously planned procedure appointment at a Michigan physician office. A left upper-arm skin lesion repeatedly catches on work clothing and bleeds. Prior evaluation documented an epidermal inclusion cyst. The physician records the symptoms and lesion findings, and the later signed follow-up adopts the pathology diagnosis of epidermal cyst without malignancy. This packet is coded after that final report is available.

Preprocedure record

Consent and site confirmation are documented. The greatest visible lesion diameter before removal is 1.6 cm. The physician marks a 0.2 cm necessary margin on each side. The left upper-arm site is identified consistently in the consent, operative note and specimen label. There is one lesion; no separate lesion biopsy is performed today.

Procedure note

After local infiltration and preparation, the physician excises the cyst and its wall through the full thickness of the skin, using the marked margins. The intact specimen is submitted to an outside pathology laboratory. The defect is closed with a single-layer simple skin closure, 3.4 cm long. There is no layered repair, extensive undermining, tissue transfer or graft. A dressing and routine wound-care instructions are provided.

Professional scope

The operating physician performs only the planned lesion procedure and its usual associated work. No significant separately identifiable evaluation of another problem occurs that day. The independent pathologist will report the pathology service under that professional role; the surgeon does not perform microscopic interpretation. The requested worksheet concerns the surgeon’s professional claim, not the laboratory’s claim.

Claim review

The draft charge list includes excision, a separate simple repair, a separate local-anesthetic administration and a visit charge for the routine preprocedure assessment. Review each proposed service against the documented relationship. For the excision itself, calculate the pre-excision diameter including the stated margins and find the correct site and size interval in the licensed book. Keep the documented symptoms available for the separate WPS coverage review.

Your coding worksheet

  1. Identify the reason for this encounter and the supported diagnoses.
  2. List the services actually completed and the applicable code sets.
  3. Use your books to select final codes, units and any supported modifiers.
  4. Sequence the diagnoses and explain the relevant instruction.
  5. Review included work and any separate coverage question. Explain why the strongest alternative does not fit.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Write your answer

Use only this fictional record. Your entries stay on this page and disappear when you leave or reload. Do not enter real patient information.

Compare with the worked explanation
  1. The final provider-adopted diagnosis is epidermal cyst. The Index route Cyst, epidermal/epidermoid leads to L72.0, which is verified in the Tabular List. The record does not establish a malignant or uncertain-behavior neoplasm.
  2. The pre-excision diameter is 1.6+0.2+0.2=2.0 cm. Use that measurement with the upper-arm site in the licensed benign skin-excision family; the 3.4 cm closure length is a different measurement.
  3. The NCCI relationship includes ordinary simple closure with this removal. The record does not describe an advanced repair that would require a separate analysis.
  4. Local infiltration and routine preprocedure work are part of the stated procedural service. The packet does not document a significant separate E/M problem; a separate heading or consent discussion does not establish one.
  5. The surgeon does not report the outside pathologist’s professional work as if the surgeon performed it. The final diagnosis can still be used when supported by the completed provider-adopted record.
  6. The repeated bleeding and friction symptoms are documented facts for the WPS policy review. Do not invent symptoms or add a separate symptom diagnosis merely to force coverage. A final claim still requires all applicable payer conditions, beyond the procedure and diagnosis choices.

Reference sections: L72.0; NCCI III E.6; WPS LCD Coverage Guidance

Practice the linked chart questions

Review the lesson

Sources

  1. CDC NCHS — ICD-10-CM April1,2026 Index and Tabular XML. April1–September30,2026. Accessed 2026-09-12.
  2. CDC/NCHS and CMS — ICD-10-CM April 1 2026 Guidelines. FY2026 April. Accessed 2026-09-10.
  3. CMS — Medicare NCCI 2026 Chapter III: Integumentary System. 2026. Accessed 2026-09-10.
  4. WPS Medicare / CMS Medicare Coverage Database — LCD L35498: Removal of Benign Skin Lesions. Revision effective October 30, 2025; currently in effect. Accessed 2026-09-10.

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