Question Wide local excision with M plasty advancement flap reconstruction

wynonna

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Hello, I am looking for the CPT codes for the following procedure to remove basal cell carcinoma.

There is 1.5 cm ulceration on right cheek. Incision is mapped with 5 mm margin incorporating bilateral M-Plasties. Incision is performed and lesion is excised in the subdermal fat layer. Specimen is labeled with suture at the anterior margin and sent for frozen section pathology which were negative. Skin edges are widely undermined. Incision is closed with vicryl for subdermis and nylon for the skin with advancement of the M plasties.
Thank you
 

thomas7331

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Excisions followed by advancement flap repair are coded in the CPT range 14000-14302 - for a lesion on the cheek it would be 14040 or 14041 (or possibly 14301-14302 if the defect was very large). Without knowing the size of the defect though, it's not possible to get to a specific code.
 

sinman0531

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The equation for an excision final measurement is the longest axis, plus two times the margin. So, 1.5cm+2(.5cm)=2.5cm excision. CPT code 11643 is "excision of malignant lesion on the face, ears, eyes, nose, or lips 2.1-3.0 cm".

As far as the repair goes, while some providers think that the phrase "extensively undermined" allows them to bill for a complex repair, it does not. The undermining must be specified to be AT LEAST as deep as the longest axis of the defect (so in this case, the note would need to say there was 1.5cm of undermining or more). Assuming the total area of the flap was less than 10 sq cm, the repair code would be 14040.
 
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