11 frozen sections done


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I am looking at this report and I tend to want to code this as 14060 and 11643, doc did state in other notes- the sizes of lesion. Other coder says since there are 11 frozen margins I should code this 11 times, I dont think this right, coder thainks Iam under coding but now she has me secound guessing . I coded this as

14060- 173.32-was stated as local rearrangement
11643- 173.32- 2.5 cm ?

any intakes on this one

PREOPERATIVE DIAGNOSES: Recurrent squamous cell carcinoma of the left preauricular area plus new lesion of the right helix.

POSTOPERATIVE DIAGNOSES: Recurrent squamous cell carcinoma of the left preauricular area plus new lesion of the right helix with 11 frozen sections done on this patient in order to clear the tumor.

PROCEDURES PERFORMED: 1. Wide excision of recurrent squamous cell carcinoma in the left preauricular area including portions of the parotid gland and the neurovascular bundle of the superficial temporal vessels and approximately 2.5 cm of skin superiorly.
2. Excision of squamous cell carcinoma, right helix excision with a wedge resection and closure with local tissue rearrangement.

OPERATIVE FINDINGS: The patient is a person who sometimes within not to distant past had a squamous cell carcinoma excised from his left preauricular area, both frozen and permanent sections were more clear on the pathology report. He was closed with V-Y advancement flap.

He presented to the office several weeks ago with a small nodule rigid in that area, which had been biopsied by dermatologist and the biopsy was that of a squamous cell carcinoma.

The lesion itself was difficult to see on the skin. The patient did complain of this area being the area of a tumor being quite hypersensitive at times.

This area was marked with a marking pen in the preanesthetic area as well as the nodular lesion on the right helix. He was taken to the operating room and placed under adequate general endotracheal anesthesia.

Initially, the actual area of the tumor which had some induration was excised and tagged at 12 o'clock and was placed in formalin by the circulating nurse.

Therefore, additional frozen sections were taken in quadrants 12 to 3, 3 to 6, 6 to 9, and 9 to 12. These were all tagged with a stitch at the proximal end of the strip that is 12 to 3 and had a stitch at 12 o'clock.

The tumor origins were marked with methylene blue.

These were all submitted to the pathologist.

A separate deep margin, which consisted of a tissue surrounding the superficial temporal vessels were then separately submitted and this included SMAS fascia in this area. Unfortunately, this deep margin was positive although the peripheral margin, which had to be clear. An additional deep margin was then taken to include everything from the conchal cartilage through approximately 1 cm strip of the posterior parotid including several small nerves, which were included in this specimen.

This was also marked with a stitch where a previous positive margin had been (about 6 o'clock on the deep margins previously) submitted. Additional tissue was taken around the superficial temporal vessels where there was a slight amount of induration. This was submitted separately.

Pathologist felt that the final two margins were clear.

Because of the concern that the frozen sections may have a different report, the area was simply closed with 3-0 nylon sutures and a Penrose drain was inserted. The opposite lid which proved to be a squamous cell carcinoma was excised as a wedge and then a local tissue rearrangement was performed by elevating the inferior helix and lobule by incising through the anterior skin and subcutaneous tissue and release any underlying cartilage has been done in the Anita Brook procedure and this was able to be closed easily with 4-0 nylon sutures. A mastoid dressing was placed on the left ear.
But my question is the surgeon did much more than just take a malignant lesion. He had to resect into the parotid gland and nerves. Would this fall under the 424xx codes?