Repair of Mohs wound

jdibble

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Hi all,

My plastic surgeon did a repair on a patient's brow and forehead following Mohs with irregular borders and uneven skin edges. She wants to bill 15004 & 13131. I think 15004 is incorrect because that is for prep of skin for skin replacement. What I am not sure is if she did enough work to also bill 11042 with the 13131. I don't think so, but since she is on internal audit I have to go over her errors with her so I need to have documentation to support what I tell her. Also, for a dx she is using Basal Cell carcinoma - shouldn't this be a "history of" code since the Mohs removed the cancer?

Below is part of her note - if someone could please tell me what the correct codes would be and the rational I would greatly appreciate it!

The wound was present along the superomedial portion of the brow and medial forehead. The skin edges were irregular and uneven. The skin edges were sharply debrided and the perimeter of the defect was sharply excised full-thickness through skin into subcutaneous tissue. The bipolar was used to remove some additional subcutaneous tissue to square the wound edges and reduce unnecessary bulk, and the dimensions of the wounds were 1.9-cm x 1.3-cm. Local anesthesia was placed in the circumference of the wound. Wide undermining was performed of the defect and then closure was performed with interrupted 5-0 PDS deep sutures and then a running 5-0 fast-absorbing plain gut and then Dermabond.

Thanks for the help!
 

mitchellde

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Jodi
I agree that the 15004 is not appropriate, I am not certain about the 11042 with the 13131, you will need to check the bundle edits, I would think the debridement would be bundled with the comples repair but then i know better than to guess!
As for the dx code you would not use the cancer code as the Mohs is considered definitive cancer treatment. But you may want to look for a code for acquired deformity of the face or forehead with thte history of cancer code. that is how we coded our Mohs repairs.
 

jdibble

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Thanks Debra for your help! According to the CCI edits, 13131 and 11042 can be used with a modifier on 11042. I just wasn't sure if there was enough there to bill the 11042 with a 59 modifier or not. I need to be sure as I will have to go back to her to tell her why her code choice was not appropriate and I'm sure she will want to know why the debridement can't be billed separately.
 

mitchellde

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the 59 would be appropriate only if it were a different wound or a separate area of the same wound from what you have stated this is not applicable so just bill the complex repair. The reason it is bundled is due to the complex repair will include any petinent debridements, ( kind of part of what makes it complex), the reason it can be modified is for those situations where there is more than one wound and one is being debrided and the other is being repaired. or there is one large wound where different areas can be separated for distinct treatment.
 
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