Can I bill for flaps????

NKenner

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I have a Doc that performed an excision of a lesion on the lip and noted in his report "Flaps were created." Can I bill procedure code 14060? I have included the "procedure" portion of the operative report.


"This 69-year-old female has a vascular ectatic lesion of the right upper lip. It is located in the vermilion border. It measures 1 cm x 1 cm. At operation, it was widely excision without incident.

The patient was taken to the operating room and placed on the operating table in the supine position. After an adequate level of IV sedation was obtained, the right upper lip was prepped and draped in the usual sterile fashion with Betadine. 1% lidocaine with 0.25% Marcaine were injected for local anesthesia. A vertical incision was made and the entire vascular ectatic lesion excised with an ellipse of overlying mucosa. The incision did not go beyond the squamous junction and was contained within the vermilion border exclusively. The lesion was completely excised. Bleeding was controlled with the Bovie electrocautery unit. The lesion was passed off as an operative specimen. Flaps were created. The skin edges were then reapproximated using interrupted simple sutures of 5-0 chromic. Antibiotic ointment was applied. All sponge, instrument and needle counts were correct x2 at the conclusion of the case. The patient tolerated the procedure well and was taken to the recovery room in stable condition."

Thank you in advance for your help!
 

armen

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I have a Doc that performed an excision of a lesion on the lip and noted in his report "Flaps were created." Can I bill procedure code 14060? I have included the "procedure" portion of the operative report.


"This 69-year-old female has a vascular ectatic lesion of the right upper lip. It is located in the vermilion border. It measures 1 cm x 1 cm. At operation, it was widely excision without incident.

The patient was taken to the operating room and placed on the operating table in the supine position. After an adequate level of IV sedation was obtained, the right upper lip was prepped and draped in the usual sterile fashion with Betadine. 1% lidocaine with 0.25% Marcaine were injected for local anesthesia. A vertical incision was made and the entire vascular ectatic lesion excised with an ellipse of overlying mucosa. The incision did not go beyond the squamous junction and was contained within the vermilion border exclusively. The lesion was completely excised. Bleeding was controlled with the Bovie electrocautery unit. The lesion was passed off as an operative specimen. Flaps were created. The skin edges were then reapproximated using interrupted simple sutures of 5-0 chromic. Antibiotic ointment was applied. All sponge, instrument and needle counts were correct x2 at the conclusion of the case. The patient tolerated the procedure well and was taken to the recovery room in stable condition."

Thank you in advance for your help!
According to CPT book this code includes Excision of leson with repair by adjacent tissue transfer or tissue rearrangement. So I dont see why you cannot bill it.
 

Jan CPC I

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Lip excision..

I think because guidelines state that there are codes in the lip section that may cover this, you might want to look very carefully at 40650 for the repair (it does not include the excsion). I think the flap might be slightly over coding this case. Just a thought. jan
 

NKenner

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I am not so sure about coding it w/ 40650, which states "repair lip, full thickness", which is nowhere reported. He clearly states an excision of a lesion on the right upper lip. I was using proc code 11442, "excision, other benign lesion, lips, excised diameter 1.1 to 2.0cm". Path report confirms 1.3 x 0.7 cm lip lesion. Am I missing something?
 

armen

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I am not so sure about coding it w/ 40650, which states "repair lip, full thickness", which is nowhere reported. He clearly states an excision of a lesion on the right upper lip. I was using proc code 11442, "excision, other benign lesion, lips, excised diameter 1.1 to 2.0cm". Path report confirms 1.3 x 0.7 cm lip lesion. Am I missing something?
I agree with you. Here is what EncoderPro says:
CPT 40650
The physician repairs a full thickness laceration of the lip. The tissues of the vermilion are closed with layered sutures.


I think 14040 is more apappropriate.
 
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