Otolaryngology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.   Question: How should I report the following operative report for post-Mohs surgery reconstruction:
"1. Reconstruction of Mohs defect right side of nose lower nose area via #1 Limberg flap reconstruction right nasal bridge and lobule 2-cm-x-3.5-cm defect.
2. Regional advancement flap nasal bony dorsum and glabella area 2-x-1-cm defect"? Georgia Subscriber

Answer: These rearrangement techniques involve reconstructive surgery to repair the Mohs defect. With the Limberg technique, the surgeon uses a transposition flap that is immediately adjacent to the defect to close the rhombus like area. The advancement flap allows the physician to cover the other area by stretching the flap longitudinally until the end comes over it. Both of these techniques qualify as adjacent tissue transfers or rearrangements, which you should report with the appropriate 14000 series code (Adjacent tissue transfer or rearrangement). When reporting tissue rearrangements, choose the correct code based on the location and size of the defect. Codes 14000-14061 are per defect, not per flap. Therefore, if the otolaryngologist uses multiple flaps to repair the same site, you should report only one tissue rearrangement code. In your case, the otolaryngologist repaired two separate defects. Consequently, you should select one code per defect. To determine the defect's size, multiply the documented dimensions. For the Limberg flap, multiple 2 cm x 3.5 cm, which results in a defect that has an area of 7 square (sq) cm. Thus, you should report 14060 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less). The advancement flap measures 2 cm x 1 cm, which results in an area of 2 sq cm and also qualifies for 14060. To indicate the surgeon operated on a separate site, append modifier -59 (Distinct procedural service) to the second defect code (14060-59). Although Mohs surgery repairs defects caused by malignancy, payers often deny these claims as cosmetic. To avoid denials, make sure to report the cancer diagnosis, such as 173.3 (Other malignant neoplasm of skin; skin of other and unspecified parts of face) in the primary position, and V51 (Aftercare involving the use of plastic surgery) to indicate plastic surgery aftercare following surgery. Also take digital pictures before and after the surgery and send them in with the appeal if necessary to show the payer that the surgery is medically necessary.