Wiki Excision/closure of BCC & SCC

[dyoungberg]

I'm a little confused on how to code this procedure. Any assistance would be most appreciated. I've chosen 11642,15260, & 14040 with dx code 173.31 for the nose and 14041 & 42410 with dx code 173.42 for neck and parotidectomy. Also chose 11100 for excision biopsy of keratosis and am awaiting lab results for dx.

POSTOPERATIVE DIAGNOSIS: BASAL CELL CARCINOMA, NOSE, EXTENSIVE SQUAMOUS CELL CARCINOMA, RIGHT NECK

PROCEDURE: RESECTION OF BASAL CELL CARCINOMA, RIGHT SIDE OF NOSE, WITH FULL THICKNESS SKIN GRAFT CLOSURE AND ROTATIONAL ADVANCEMENT FLAP CLOSURE OF DONOR SITE, RESECTION OF SQUAMOUS CELL CARCINOMA, RIGHT NECK WITH PARTIAL PAROTIDECTOMY

COMPLICATIONS: NONE

OPERATIVE FINDINGS: There was a 1.2 cm in diameter shallow erythematous scar involving the right nasal ala, central third. There was a 2 cm in diameter deep ulceration on the right neck in the posterior triangle at about the level of Erb's point. Deep to the lesion was a 2.5 cm in diameter area of induration extending down to the trapezius muscle.

DESCRIPTION OF PROCEDURE: Under IV sedation, the patient was prepped and draped in a sterile manner in order to give good exposure to the head and neck. The previously noted areas were infiltrated with about 20 cc of Lidocaine 1% with Epinephrine 1:100,000. Attention was first turned to the nose where a 1.2 cm in diameter area of full thickness skin was excised encompassing the lesion. The adjacent skin margins were undermined and a full thickness skin graft harvested from the lip cheek crease on the right was inset into the defect and sutured in place with 5-0 Rapide and 4-0 Prolene, tied over a bolster of Adaptic and a cotton ball moistened with Betadine.

Attention was then turned to the neck where a 7.5 x 3 cm fusiform of skin and subcutaneous tissue down to the trapezius muscle was excised, encompassing the lesion. The adjacent skin was undermined, rotated, and advanced to fill the defect. The subcutaneous tissue was closed with 3-0 Monocryl and the skin closed with 5-0 Rapide.

Frozen section histoanalysis revealed persistent tumor on the anterior margin, both in the skin and in the deeper subcutaneous tissue. For this reason the wound was reopened and a fusiform segment about 1.5 cm x 4 cm was excised along the anterior border. This was carried down through the deep subcutaneous tissue and the tail of the parotid which was amputated. The wound was then closed in rotational advancement flap fashion. The adjacent skin was undermined, rotated, and advanced to fill the defect. The subcutaneous tissue was closed with 3-0 Monocryl and the skin closed with 5-0 Rapide.

The lip cheek crease donor site had a defect approximately 6 x 1.5 cm. This was closed in rotational advancement flap fashion. The adjacent skin was undermined, rotated, and advanced to fill the defect. The subcutaneous tissue was closed with 4-0 Monocryl and the skin closed with 5-0 Rapide. Polysporin ointment was applied and the patient awakened and returned to the recovery room in good condition. There were no complications.

A 2 cm in diameter area of keratosis was removed along the anterior border of the neck excision. This was sent for permanent histologic exam.

Frozen section histoanalysis revealed the final margins clear of tumor in both specimens.

Thanks very much!

Debbie CPC
NW FL SURGERY CENTER

 

[Texascoder64]

regarding the first procedure for the BCC nose - you can not bill the excision with the adjacent tissue transfer (flap). So only use the graft and flap code (omit the excision)

 

[anncamp1]

Billing/Coder

This my first time logging in. I hope I am doing this correctly.
I have a question.
My doc has put 17000 on with Basal cell carcinoma 173.31 and
17003 with 702.0 Actinic Keratosis. Does this look correct to anyone? Different locations. I know to put a 51 on the 17003.
Please advise if you know.
Thanks RW

 

[CatchTheWind]

Welcome to the forum anncamp1!

To ask a new question, you should choose the "new thread" button on the upper left above the list of all the ongoing threads. (Be sure to give it a title that indicates with some specificity what your question is about (not just "need coding help" or something generic like that.))

As for your question, you cannot use CPT code 17000 with a skin cancer code, because 17000 is only for destruction of actinic keratosis. If the doctor had destroyed two AKs, you would code a 17000 and a 17003, both with diagnosis 702.0. (And actually, you do not need a 51; first of all, many carriers never require a 51 on anything (we never use it at all in our practice) and even if you have a carrier that does require it on "additional" procedures, the 17003 is an "add-on" code, so the code itself indicates that it is an additional procedure, thus overriding the need for the 51 modifier.)

If your doctor performed two destructions, one for an AK and one for a BCC, you would code as follows:

172xx with 173.31
17000 with 720.0


(These codes don't bundle with one another, so you don't need a 59.)