sgremmels
Guest
I originally posted this in plastics but ENT's often do the reconstruct portion. so here goes... I need some serious help in understanding what codes other than 15630 should be used. 14040 states an incision must be made and the pedicle was incised... does that count? If you have anything to offer, I would appreciate any and all help! Thank you!!!
Patient had MOHs surgery by derm and this is stage II nasal tip reconstruction by the ENT:
A transection point was selected. Next working on the proximal end of the flap, skin was elevated with a 2 mm cushion of fat underneath it. This allowed the excess tissue below to be carefully removed. This included scar and a small amount of muscle. An inverted V inset site was created. This allowed for some thin scarred tissue to be removed from the forehead proper. The proximal end of the forehead flap was able to be inset with good visual contour. After this was trimmed to proper size, it was secured using ................. Attention was next turned to the distal portion of the flap covering the nasal tip. Again markings were made on the nasal tip indicating a generous 1 cm attachment area that would not be violated during the procedure. This was slightly tilted toward the left as the left side appeared very cosmetically favorable whereas the right side of the flap was a bit proud and would benefit from debulking. The skin was elevated from this distal end leaving a cushion of 2 mm of fat.This allowed the residual scar and remaining tissue to be trimmed from the nasal tip. On the right side the flap was carried down slightly lower in accordance to the markings made earlier. The edges were carefully refreshed and the receiving skin undermined for mobility. A slight revision of the edge of the superior portion of the nasal tip was also created to allow for access to better appearing skin and a smooth cut surface that was symmetric. This flapwas carefully trimmed to match the recipient site and required numerous revisions to have an exact fit. Once achieved for both size and level, the skin was reapproximated .....................
Patient had MOHs surgery by derm and this is stage II nasal tip reconstruction by the ENT:
A transection point was selected. Next working on the proximal end of the flap, skin was elevated with a 2 mm cushion of fat underneath it. This allowed the excess tissue below to be carefully removed. This included scar and a small amount of muscle. An inverted V inset site was created. This allowed for some thin scarred tissue to be removed from the forehead proper. The proximal end of the forehead flap was able to be inset with good visual contour. After this was trimmed to proper size, it was secured using ................. Attention was next turned to the distal portion of the flap covering the nasal tip. Again markings were made on the nasal tip indicating a generous 1 cm attachment area that would not be violated during the procedure. This was slightly tilted toward the left as the left side appeared very cosmetically favorable whereas the right side of the flap was a bit proud and would benefit from debulking. The skin was elevated from this distal end leaving a cushion of 2 mm of fat.This allowed the residual scar and remaining tissue to be trimmed from the nasal tip. On the right side the flap was carried down slightly lower in accordance to the markings made earlier. The edges were carefully refreshed and the receiving skin undermined for mobility. A slight revision of the edge of the superior portion of the nasal tip was also created to allow for access to better appearing skin and a smooth cut surface that was symmetric. This flapwas carefully trimmed to match the recipient site and required numerous revisions to have an exact fit. Once achieved for both size and level, the skin was reapproximated .....................