Otolaryngology Coding Alert

Question: Our otolaryngologist re-excises a 3.5-cm neck scar that requires layered closure after a previous thyroidectomy. The note states the original wound was a Z shape. Does that make it a Z-plasty? Which code should I use?

Missouri Subscriber

Answer: Thyroidectomies may leave extensive scarring, which an otolaryngologist may repair years after the original procedure. The physician may excise the scar and close the wound with any number of techniques, such as closure, flaps or adjacent tissue transfers. Unless the documentation states a Z-plasty, you should not code one. Just because the wound looks like a Z does not mean the doctor performs Z-plasty to cover the defect. You should code based on the kind of repair.

In this case, the otolaryngologist uses layered closure or intermediate repair (12042, Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm) to close the excision. Because the repair requires intermediate closure, you should also report the excision, 11424 (Excision, benign lesion including margins ..., scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm), appended with modifier -51 (Multiple procedures) to indicate an additional same-day procedure.

Presumably, the 90-day global period for the thyroidectomy has expired. So, you do not need a postoperative modifier on the codes.