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excision of lesion - what do you get?

  1. #1
    Question excision of lesion - what do you get?
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    Coding for excision of malignant lesions is not something I am comfortable with, so I want to get other opinions on the correct choice of codes. The surgery note is as follows, what do you come up with?

    " presented with a skin cancer just in front of the tragus of the left ear. This was an obvious ulcerated area about a centimeter in greatest dimension, but had erythematous induration extending in all directions for a greater distance. The area of induration was thought to perhaps be an extension of this skin cancer beneath the epidermis involved an area of about 5 cm in length and 2 cm in width. Therefore, the excision included this entire area.

    DESCRIPTION OF PROCEDURE: With the patient supine on the operating table and with his head turn to the right and under IV sedation as administered by anesthesia, the left ear and area just anterior to the left ear was prepped with DuraPrep and draped in the usual sterile manner. Local anesthesia was provided by the injection of a solution that was one-half 1% Lidocaine without epinephrine and one-half 0.25% Marcaine with epinephrine 1:200,000. A total of 20 ml of this combined solution was injected into the operative area. The skin cancer was excised with an ellipse of skin. This elliptical excision was as noted above 2 cm x 5 or 6 cm.

    This wound was too large to close even with mobilization of the skin anteriorly. The specimen was marked and sent from the table as specimen. The incision was therefore extended anteriorly at the cephalad end of the excision site to create a flap. This was at about a 30-40 degree angle from the essentially longitudinal angle of the elliptical excision. This extension was for another couple of centimeters. This allowed for mobilization of the skin enough to close the defect. The skin was then mobilized anteriorly. Electrocautery was used for hemostasis. The dermis was then approximated with multiple interrupted sutures of 2-0 Vicryl. A running subcuticular suture of 4-0 Vicryl was then placed to close the skin. The skin was sealed by application of Dermabond and a sterile dressing was applied to create pressure to prevent accumulation of fluid".

  2. Default excision maligant lesion
    I would code that 11646

  3. #3
    Default
    I also got 11614, but i also code the 2-layer skin closure as well?

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Flap?
    But the body of the note says The incision was therefore extended anteriorly at the cephalad end of the excision site to create a flap. This was at about a 30-40 degree angle from the essentially longitudinal angle of the elliptical excision. This extension was for another couple of centimeters. This allowed for mobilization of the skin enough to close the defect.

    This documentation is definitely lacking. But 1404x INCLUDES the excision of the lesion.

    I'd query the physician for some clarification. If he truly needed an advancement flap to close the defect then you should code only for the flap and not code for the excision at all (as per CPT guidelines).

    F Tessa Bartels, CPC, CEMC

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