69110 or 69120?

[gallhart005@yahoo.com]

Hi all! I am having trouble deciding which code I should select for the auriculectomy. My doctor wants to use 69120, but my research says 69110. Please help!

The patient was identified in the preoperative holding area and informed consent was obtained. All risks, benefits, and alternatives of the procedure were discussed with the patient and they decided to proceed with the surgery. The patient was brought back to the operating theater and was placed supine on the operating room table. Anesthesia began general anesthetic induction and intubated the patient without difficulty. We performed a timeout, identifying all members of the operating room staff, patient, and procedure to be performed. The patient was then turned 90° to the operating room surgeon. The patient was prepped and draped in the normal sterile fashion. Facial nerve monitor was connected to the patient and deemed to be working at the beginning of the case. A 1 cm margin was drawn out circumferentially around the right postauricular tumor. This margin involved essentially the entirety of the ear with the exception of the lobule and most superior aspect of the helix of the right ear. At this point I began with a total auriculectomy. The skin was incised circumferentially around the tumor including the 1 cm margin of normal tissue. I dissected down to the level of the periosteum of the mastoid. The temporalis muscle was used as the deep margin of the dissection. I moved my dissection anteriorly to the level of the lateral external auditory canal. I then made anterior cuts through the conchal bowl of the ear as well as the antitragus and helix superiorly. This completely freed up the ear. The involved mastoid skin was additionally excised along with the primary specimen by creating a 1 cm margin around the involved mastoid skin. The entirety of the ear as well as the adjacent involved mastoid skin was excised in this fashion and sent for routine pathology. At this point I sent margins circumferentially from around the ablative site. All margins returned as negative for residual basal cell carcinoma. At this point I had a large 6 x 4 cm defect needed to reconstruct. I designed a adjacent rhombic flap I incised the skin and elevated the rhombic flap off the scalp. I ensured I had a broad base to the flap to preserve vascularity. The flap was rotated over the primary defect and sutured into place using 3-0 Vicryl suture. The donor site was closed by advancement of adjacent skin. Finally the skin was closed with 5-0 Prolene suture. A mastoid Glasscock dressing was applied. This completed the surgical portion of the procedure. There were no complications. Anesthesia awoke the patient and transferred the patient to the PACU where the patient remained in stable condition

 

[maebelle@gmail.com]

The documentation indicates that the entire ear was removed. Even though the margins of the tumor did not involve the entirety of the ear, the physician documented that the entire ear was removed. I would use code 69120.