Question How would you code this


Reno, Nevada
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I am newer coder to Dermatology coding and this OP Note has me puzzled. If someone can point me in the correct direction I would be greatful. Here is the OP Note from the doctor.

Procedure: Closure of Mohs defect left Pinna

Postoperative Diagnosis: Mohs defect lateral aspect of left pinna measuring 2 cm in diameter

The patient was already on the operating table in the supine position. His ear and left side of his face were prepped and draped in the usual way. The patient had a fairly large defect on the lateral aspect of his mid ear extending almost to the helical rim, but not quite. It exposed the underlying cartilage over quite a large area. A flap was designed on the posterior aspect of the ear which was anteriorly based rectangular in shape and contained within a vertical ellipse centered in the postauricular fold. The idea was that this flap would hinge anteriorly, be passed through the cartilage of the ear and turned to resurface the lateral aspect of the pinna in the region of the defect.

The entire area was infiltrated with 1% Xylocaine and 1:100,000 parts epinephrine. The superior and inferior traingles of the ellipse were then excised leaving the anteriorly based rectangular flap contained within the elliptical defect. The posterior aspect of this flap was the separated from the posterior incision line so as to give a hinged anteriorly based flap. The design of this flap was such that it would hinge and pass through the cartilage and be in exactly the right position to reconstruct the lateral skin defect. Accordingly, a vertical slot was made in the auricular cartilage near the base of the flap. To this a strip of cartilage was removed 3 mm in width and 2 cm in length. The flap was then turned and passed through this defect with interrupted sutures of 5-0 prolene. Posteriorly hemostasis was achieved using the Bovie and the wound was meticulously closed with interrupted and continuous sutures of 4-0 Chromic catgut. Some care was taken to use the sutures to obliterate the dead space deep to the suture line. Finally, an absorbent dressing was applied and this was held in place with a head bandage. Head bandage consisted of ABD dressings, Kerlix bandage and them a tensor bandage over the top.

The patient was asked to keep this in place for at least 48 hours at which time he will make a return visit to the office.

It should be pointed out that this patient has a very large defect on his right cheek eyelid junction. This is a Mohs type excision but the lesion is a lentigo maligna and it is being sent for permanent section before a decision is made to repair the defect. This will take some days, do the patient has been placed by Doctor on antibiotics pending histological review and ultimate closure

As today the patient tolerated the procedure extremely well and left the OR in satisfactory condition.