The doctor did an excision of gouty tophi and I am at total loss as exactly how to code this. The operative report says an incision was made over the elbow first, about 1 1/2 inch in length and carried deep to the level of the skin only. Excision was made of a fish eye portion of tissue and the gouty tophi was excised along with this. The gouty tophi were protruding through the skin and that area of skin protrusion of the tophi was excised. Closure by 4-0 PDS and staples for skin.