Wiki graft and complex repair on same site

[CatchTheWind]

If an excision is closed by performing complex repair on part of the wound and a graft on the other part, can you bill for the complex repair and the graft. The coding specialist at the AAD says no, but the medical direct at Modernizing Medicine says yes. Who's right?

 

[bwmartin]

I am having this very discussion with my Mohs surgeon and a plastic surgeon right now. When I look at it through my coding lens they are bundled per CCI. Per the physician's lens they are two separate procedures and should both be billable. Here is the scenario put before me. A defect on the nose is closed with complex repair BUT one end is too tight to close so a full thickness graft is taken from the opposite end of the wound (the burrow's triangle end of the complex repair) and placed as a graft in the area that is too tight to close. This brings me to ask the question as well as to what size am I basing the graft on... the original defect size after removing the cancer (if billing only the graft considering the complex closure is bundled) or the size of the remaining defect after the complex closure was performed (in which case it seems it should be considered two separate procedures).

Any thoughts? No one seems to want to answer this question.