Question 14040 and acceptable diagnoses

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Below is part of the surgeons op note for a soft tissue mass excision. The surgeon is stating there was a "void" left from the mass excision that required a skin flap from the medial left foot to cover. Would 14040 be acceptable? Also, what diagnosis codes would be appropriate. I have several in my coding companion for Podiatry but not sure they apply as they are injury codes.

"Surgery began in the following manner:
Attention was directed to the left foot where a palpable mass was noted sub 1st met head. A circumferential incision was then made directly over the mass. The incision was deepened using both sharp and blunt dissection with care taken to avoid all vital neurovascular structures. The mass was carefully dissected free from all surrounding tissues and was then removed in toto. The mass was sent to pathology for further evaluation via fresh frozen section. The mass was approximately 4.5 cm x 3.5 cm. The remaining subcutaneous tissues were then explored and noted to be normal in appearance. The incision was then deepened with blunt dissection, and it was noted that there were no signs of stalking of the mass, abscess formation, or active drainage from the site.

The wounds were then flushed with copious amounts of normal saline solution. The void left by the soft tissue mass excision required a skin flap from the medial left foot to cover. The skin flap was retained with its vascularity and was full thickness, rotted over the void."



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The skin flap/tissue transfer procedure is the closure for the excision of the mass, so the diagnosis you would use will be the diagnosis for the mass, which you would usually get from the pathology report. Flaps are relatively common procedures done in conjunction with dermatology procedures to remove large skin, subcutaneous or soft tissue lesions, so the lesion diagnosis should be acceptable to any payer. I'd add that if the code for the excision is a skin/subcutaneous code (CPT range 11400-11646), then the excision would be considered incidental to the flap procedure and shouldn't be separately reported.