Wiki flap takedown with nose tip reconstruction


Owls Head, ME
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Patient had MOHs surgery by derm and this is stage II nasal tip reconstruction by the ENT. This is my first flap and reconstruction to code and I am in need of help. If someone could point me in the right direction, it would be most appreciated. I know we use CPT 15630 but there seems to be something else I should be using and can't quite figure it out. Thank you in advance to anyone who is willing to assist. A portion of the note follows:

Marking pen was used to mark the nasal landmarks including the nasal ala,dorsum,lateral sidewalls, and tip. The forehead scar was also marked.
A transection point was selected. Next working on the proximal end of the flap, skin was elevated with a 2 mm cushion of fat underneath it. This allowed the excess tissue below to be carefully removed. This included scar and a small amount of muscle. An inverted V inset site was created. This allowed for some thin scarred tissue to be removed from the forehead proper. The proximal end of the forehead flap was able to be inset with good visual contour. After this was trimmed to proper size, it was secured using ................. Attention was next turned to the distal portion of the flap covering the nasal tip. Again markings were made on the nasal tip indicating a generous 1 cm attachment area that would not be violated during the procedure. This was slightly tilted toward the left as the left side appeared very cosmetically favorable whereas the right side of the flap was a bit proud and would benefit from debulking. The skin was elevated from this distal end leaving a cushion of 2 mm of fat.This allowed the residual scar and remaining tissue to be trimmed from the nasal tip. On the right side the flap was carried down slightly lower in accordance to the markings made earlier. The edges were carefully refreshed and the receiving skin undermined for mobility. A slight revision of the edge of the superior portion of the nasal tip was also created to allow for access to better appearing skin and a smooth cut surface that was symmetric. This flapwas carefully trimmed to match the recipient site and required numerous revisions to have an exact fit. Once achieved for both size and level, the skin was reapproximated .....................
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