Wiki reconstruction of outer ear following surgery

[CatchTheWind]

If the surgeon removed a skin cancer from the helix, which left "pieces of skin sticking out" (in the surgeon's words) which later had to be excised and closed, what diagnosis and CPT code would you use?

 

[nsteinhauser]

Can you post the scrubbed op note? Without details, I would lean towards a removal of malignant lesion 1164x (and intermediate or complex closure if appropriate.)

 

[CatchTheWind]

Unfortunately, our EMR requires the provider to choose a diagnosis and procedure before it will populate the notes. Since the provider doesn't know what diagnosis and procedure to call this, thee is nothing in the notes yet except a CC/HPI that says:

This is a xx year old male who comes in for delayed repair of surgical defect following Mohs surgery. Mohs was performed on a basosquamous cell carcinoma, x/x/15, on the left inferior helix.

Note, however, that there was ALREADY a repair done at the time of the surgery, and this is a revision of the original repair.

 

[mamarchant]

I would use a complex repair code 1315X unless something much more skillful needs to be done to recreate the helix (eg. some type of graft). One could also argue the use of 13160- secondary closure of surgical wound if the Mohs surgeon left a mess of the helix and there is an open/non-healing wound that should be addressed expeditiously. (Insurance companies in my state tend to deny coverage of the complex repair codes- get the procedure predetermined unless the case is urgent. In that case, I would use the secondary closure code.) Hope this helps.