Moh's Defect

michiboo

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Having some discussion and some confusion, new to derm, provider wants to bill 12051, 12052, 12053, 12054, 12055, 13131, 13132, 13133, 14040 and 14041 ..

I don't agree with the multiple closures or flaps codes unless am interpreting it incorrectly. I agree with just one closure.

Can someone take a look and see what they get as far as codes..



Report:

Assistant(s): none


Pre-procedure diagnosis:
Mohs defect of forehead, history of basal cell carcinoma


Post-procedure diagnosis: same as pre-procedure dx


Anesthesia: monitored anes. care


Estimated blood loss in ml's: 5cc


Specimens removed/altered: Medial and Lateral triangles (of skin, margin from Mohs defect; skin of forehead)


Complications: none


Implant(s): none


Procedure(s) performed:
Reconstruction of Mohs defect with complex closure


Technique/Procedure:


Surgical plan was discussed with Pt PreOp. Site was marked. Pt was taken to the OR and placed in supine position. After M.A.C. was induced, Pt was prepped and draped in the usual sterile fashion. A surgical pause was performed, then surgery began. The defect was measured at 13x16mm, full-thickness. An ellipse was designed based on existing rhytides and RSTLs. The planned area of excision and dissection was injected with local anesthetic (5cc total of 1% lidocaine with 1:100,000 epinephrine). After allowing time for effect, the ellipse was incised and the medial and lateral triangles of skin were dissected and passed off the field as specimen (confirmed with circulating RN). The wound edges were widely undermined to minimize tension of closure. Wound was copiously irrigated and then wound was closed in layers: interrupted 2-0 Vicryl for the deep tissue, thern 3-0 Monocryl for the dermis, and then running 4-0 Monocryl for the subcutis. Incision was cleaned, dried, and dressed with mastisol and steristrips.


Length of closure: 39mm.


A compression dressing (TELFA, 4x4 gauze, MediPor tape) was applied.


Pt tolerated the procedure well and as awoken from M.A.C. and taken to PACU in stable condition.


All sponge and needle counts correct x 2.


Incision 1046


End 1133


Operative findings:


Mohs defect 13x16mm, full-thickness


Disposition: plan to D/C home, PACU
 
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