Use Repair, Flap or Graft Codes to Report Mohs Reconstruction
Published on Fri Mar 01, 2002
Although a dermatologist or plastic surgeon typically performs Mohs micrographic surgery, an otolaryngologist may be called in to repair the surgical wound.
Mohs surgery is a precise technique for treating skin cancers, such as basal cell and squamous cell carcinomas. It has become widely available in the last few years and reportedly has the highest cure rate of any skin cancer treatment. Because Mohs surgery eliminates virtually all malignant cells with minimal damage to the surrounding skin, the technique is used most often for malignancies on the face and in cosmetically sensitive areas. Mohs may also be used to remove skin cancers with ill-defined clinical margins and recurrent skin cancers.
"The surgery is better for patients because they lose less skin," says Pam Biffle, CPC, CCS-P, director of Medical coding for Concentra, a large occupational healthcare group in Addison, Texas. "This isn't at all like an excision with wide margins. If the pathology comes back positive, they take out another specimen until there is no further sign of the cancer. Based on what is seen, the surgeon can determine if it is necessary to remove another layer." Even though the original procedure is unusual and the cancer, as well as the wound, is likely to be irregularly shaped, the same repair codes apply to Mohs reconstruction as for any other closure, Biffle says.
Because Mohs surgery is more sensitive cosmetically, many patients who have the procedure require only simple closure. Sometimes, however, closing the wound may require intermediate (layered) or complex closure (13000 series), adjacent-tissue transfer (14000 series), or flaps and/or grafts (15000 series).
Repairing the Wound
The surgeon may apply a dressing after a Mohs procedure and send the patient to the otolaryngologist, who may determine the wound should be left open to heal on its own or perform one of many closures (simple, intermediate and complex repairs; adjacent tissue transfers; more extensive flaps; and, in extreme cases, grafts). Biffle notes that the nature and size of the wound, which can vary considerably because the malignancies tend to be irregularly shaped, are the determining factors. If an intermediate or complex repair is performed, the size of the defect must be documented to select the correct code. The same applies to tissue transfer and grafts.
Most of these repair codes also vary by location, but repairs by otolaryngologists are most likely to be on the face and/or neck. For example, Mohs surgery for a basal cell carcinoma of the cheek leaves an 8.5-sq cm defect. The repair is coded 14040 (Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, [...]
