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Hello. I am needing some advice on coding the secondary excision of the elliptical shape. Please review the op note.

The patient's left posterior calf was cleansed with chlorhexidine. A sterile surgical pen was used to mark the borders of the skin surrounding the lesion. 1% lidocaine with epinephrine was injected into the skin surrounding the lesion. A 2.8 cm x 2.3 cm oval incision was made in the skin surrounding the lesion. Dissection proceeded into the subcutaneous space sharply. The lesion was dissected free from underlying tissue in a subcutaneous plane using sharp dissection. A nylon suture was used to mark the 12 o'clock position on the specimen. The specimen was subsequently sent to pathology for further evaluation. Adequate hemostasis was achieved at the wound base using electrocautery. Pathology revealed residual basal cell carcinoma with negative margins circumferentially and deep. Given the size and the location of the defect, the decision was made to convert the defect into an elliptical shape and then perform layered closure. A 7.5 cm x 2.5 cm ellipse was drawn at the posterior left calf, encompassing the entirety of the defect. Additional 1% lidocaine with epinephrine was injected into the skin surrounding the ellipse. Incisions were made sharply at the markings. Dissection proceeded into the subcutaneous space sharply. The 7.5 cm x 2.5 cm ellipse of benign skin and soft tissue at the left posterior calf was then excised in a subcutaneous plane using sharp dissection. In this manner, the oval defect was successfully converted into an elliptical shape. The skin and soft tissue surrounding the ellipse was undermined generously and circumferentially to assist with layered closure. Adequate hemostasis was achieved using electrocautery. The 7.5 cm long incision at the left posterior calf was then closed in layers. The deep tissue was closed with interrupted 3-0 Vicryl suture. The skin was closed with a running 4-0 nylon baseball stitch type suture.

Per AAPC If the re-excision occurs during the same session as the initial excision, report a single code to describe the greatest area removed. For example, if the first excision measures 3.0 cm with margins, and the second excision increases the margins by 1.0 cm on all sides, code for a 5.0 cm excision. Do not separately report a 3.0 cm excision and a 5.0 cm excision.

Would this rule apply here because the MD is stating pathology was negative for BCC and the secondary excision was benign skin and tissue? (11603/11406/12032 or 11606/12032)

Thank you.
 
Last edited:

nickelclaw

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Peru, IN
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Hello,
I would code the 13121 7.5 cm complex repair. Given the excess ellipse of tissue that was removed for closure and the stated undermining this is a complex repair. For excision measurements off of the first excision. If this was a re-excision to clear margins then you would add the first and second measurements.
Hope this helps!
 
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