Wiki closure of lesion ellipse

TnRushFan

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I know a lesion excision is the size of the lesion + margins x 2 (not the ellipse) and anything other than simple closure can be separately reported.

Is it appropriate to include the entire length of the surgical wound (including the ellipse) in the closure code? I think since the intermediate closure is reported separately it should include the ellipse, my co-worker disagrees.

0.5 cm margins
elliptical incision was then marked out with a 2.5:1 ratio
10x8mm malignant neck lesion

Total excision size 2cm
Total intermediate repair 7cm
11622
12042-51
 
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No, you do not measure around the would that would be circumference not length. You ignore the width and just measure the length. Its not the best formatting in this link:

http://www.the-dermatologist.com/content/size-matters

7. Longest Length of Elliptical Incision Repair codes for intermediate closure (CPT codes 12031 to 12057) and complex repairs (CPT codes 13100 to 13153) are based on the longest length of the elliptical incision. Using the first example in #2 in which the physician performed an elliptical incision measuring 3.4 cm wide and 7.5 cm long, the repair code is selected based on the length of the ellipse (eg, 7.5 cm). Repair codes are measured in straight centimeters. Be sure that the operative report clearly differentiates between the excised diameter and the defect length.
 
thank you, a little further clarification please...

- no margins - the 1 cm lesion + 2.5 ratio (x2) would be 6 cm closure?
or for the closure would I only code the size of the lesion + margins with no direct ellipse length documented?
 
thank you, a little further clarification please...

- no margins - the 1 cm lesion + 2.5 ratio (x2) would be 6 cm closure?
or for the closure would I only code the size of the lesion + margins with no direct ellipse length documented?

The excision should be the largest excised diameter (10 mm or 1 cm) plus the margins on each side (0.5 x 2 = 1 cm), so the 2 cm excision is correct.

For the closure, you'd just use the 7 cm assuming that is what is documented.

The ratio of the ellipse does not give you any measurements - you would need to know the measurement of the length of the axis of the ellipse that was closed, so I would not use that information to calculate a closure. The size of the lesion that is excised does not always correspond to the length of the incision or defect that has to be created in order to remove it - the defect can be longer (or even shorter in some cases) as the provider might need to extend the defect beyond the dimensions of the original excision in order to get a satisfactory result. In order to code correctly, the provider really needs to document the lesion size and the closure size separately.
 
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