Re-excision for margins

KJenkins588

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Hello all,
Here is the scenario...patient recently underwent radical resection on the pelvis/hip area. We used 27049 as it was quite large. Patient is now being brought back to remove margins. I'm reluctant to use the 116xx codes since he is going deep to get more tissue but that is what all my research is telling me to do. I have the op report below. Any suggestions would be appreciated! Thank you! Also...everything taken was found to have no residual sarcoma.

Her old scar was opened up sharply. the positive or close margins were the superior margin and the deep margin. I reexcised the superior margin with cautery to a depth of about 1.5 to 2 cm. This was all fat. It was marked with yellow paint for the superior margin and was sent to pathology. It was difficult to tell where the previous deep or muscular margin was. I definitely saw 1 area was more scarred in. I excised this area sharply with cautery taking about a 1 cm deep margin of tissue through the lateral buttock muscle. This was marked with green paint for the deep margin and sent to pathology. There was a questionable area of what looked like previous muscle resection and this was just above the deep and inferior margin. This area was excised with 1 cm deep muscular tissue. The deep margin on this one was marked with green ink. After inspecting the wound bed....etc etc.

Again, thank you for any help!
 
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I'm pretty sure that 27049 includes the excision of margins by definition; "excision of the mass and surrounding tissues, with the diameter of the tumor and its margins measuring less than 5 cm". Is there a reason the patient is returning for removal of margins (again)? Also, I know he's getting more tissue, but is there a reason for that? If this is an unplanned re-excision, coding with that in mind might be the way to go (with the appropriate modifier). If this was due to an increase in margin size, maybe you could recode with 27059-58 because it's now larger??
 
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