Wiki Closure codes

[pcorbisiero1231@comcast.net]

Please help with the following: Do you code for the complex closure of the lower lid if a flap closure is performed as well?

PREOPERATIVE DIAGNOSES: Open wound of right lower lid, status
post Mohs excision, right lateral canthal laxity, defect of
right cheek, right forearm mass, right wrist mass.
POSTOPERATIVE DIAGNOSES: Open wound of right lower lid, status
post Mohs excision, right lateral canthal laxity, defect of
right cheek, right forearm mass, right wrist mass.
PROCEDURES PERFORMED:
1. Flap closure of right lower eyelid and cheek.
2. Right lateral canthoplasty.
3. Right orbicularis oculi muscle flap.
4. Complex closure of right lower lid, 1.5 cm.
5. Recreation of right lateral lid canthus with adjacent
tissue transfer of 1.5 cm2.
6. Excision of right forearm mass, 1.2 cm superficial.
7. Flap closure of right forearm.
8. Excision of right wrist mass, 1 cm deep.
9. Intermediate closure of right wrist.
10. Right supratrochlear, right supraorbital and right

 

[sequester25@gmail.com]

PROCEDURES 2,3,5 I would go with 67961 - E4, also feels like procedure 1 is also included with this code...it does feel like there could be some other codes for the cheek flap

procedures 6,7 - 11402 - excision of arm 1.2cm -- need more info on the closure...does he describe the incision he made over the mass of the forearm...also look at 25075 (should include the closure)

procedures 8,9 - look at 25076 (should include the closure) with 12031 (double check edits for bundling)

hope this can steer you in the right direction and maybe someone with more experience can expand on this

 

[pcorbisiero1231@comcast.net]

Next, he was taken to the operating room. After adequate
general anesthesia, all bony prominences were well padded.
Pneumatic compression stockings were placed and IV antibiotics
were given. The face and right arm were prepped and draped in a
sterile fashion. Attention was first turned into the right arm.
Right forearm mass was excised, superficial planes 1.2 cm and
sent for pathologic analysis.
This was taken down to the deep subcutaneous layer.
There was a deep soft tissue defect. The fascial flap was
developed and backcut and rotated to fill the defect. It was
inset with interrupted 4-0 Monocryl suture.
Skin flaps were then elevated and advanced. Multilayered
closure was performed with 4-0 Monocryl deep, 4-0 Monocryl deep
dermal, 5-0 Monocryl deep dermal, 5-0 Monocryl as subcuticular
stitch, and 5-0 fast-absorbing plain gut suture on the skin.
Flap closure was inset. Flaps were well perfused.
Next, attention was turned to a distinct surgical site, right
wrist. Mass was excised from the deep planes down to the deep
fascial planes. It measured 1 cm and sent for pathologic
analysis. The wounds were once again irrigated and hemostasis
was obtained. Multilayered closure was performed with 4-0
Monocryl deep, 4-0 Monocryl deep dermal, 5-0 Monocryl deep
dermal, 5-0 Monocryl as running subcuticular stitch and 5-0
fast-absorbing plain gut suture. Benzoin and Steri-strips were
applied with Medpor dressings.
Next, attention was turned to the right lower eyelid defect.
The defect was in the area of the lower lid and cheek junction.
There was significant lower eyelid laxity. This was status post
Mohs excision.
A rotation advancement flap was developed. An incision was made
laterally and then elevated and rotated medially and superiorly
to alleviate tension on the lower lid.
Orbicularis muscle had been excised in the procedure. An
orbicularis muscle flap was developed. Triangular backcut was
created and rotated to fill the defect. Orbicularis muscle was
inset with interrupted 6-0 Monocryl buried suture.

 

[sequester25@gmail.com]

25075 -RT (FOREARM)
25076 -XS/RT (WRIST)

14020 - forearm closure
12031 - wrist (check edits for bundling)

Lower lid:
67961 - im getting directed to this in the index for the tissue transfer...make sure you use the correct modifiers...this will include the canthus but the documentation is leaning towards the bottom two

15845 - index gives me this code when looking up: CHEEK>MUSCLE TRANSFER - This code does not allow for lower eyelid modifiers to give you more specificity to the junction of the cheek and lower lid
14060 - this code is specific to eyelid adjacent tissue transfer - make sure your modifiers are correct

again please check your NCCI edits for bundling...

This is where my experience with eye reconstruction and tissue transfers has gotten me.

hope this helps

 

[pcorbisiero1231@comcast.net]

It sure does! Thanks so much.