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Wide excision of nevus with layer closure

  1. #1
    Default Wide excision of nevus with layer closure
    Medical Coding Books
    DX - Right hip congenital nevus
    Procedure : Wide excision of nevus with multiple closure.
    The area had been mark in the preoperative holding area . It was on the hip. IT was prepped and draped in normal fashion. A marking pen was used to ensure we have 1.5 2.0 cm mark all the way around. a 10cc of 1% lidocaine with epinephrine was used to inject in subdermal area . A large 12-15 cm I-SHAPED incision was made to include entire lesion in oval. This was done all way down to the subcutaneous fat. A specimen was removed and sent to Pathlogy. Excellent hemostasis was noted to be obtained. The wound was closed in two layers with flaps with 3-0 and 4=0 vicryl in subcuticular fashion. It was noted to come together excellently without evidence of tension. Steri-STRIPS and sterille dressings were placed.

    path report came back as a congenital compound nevus- 216.7
    my question is this
    Do i code 27047-with dx code 216.7
    or do i code 11426 with layer closure
    which one would you choose, and why ?

  2. #2
    Milwaukee WI
    Default More questions for you
    First, in general we code excision of nevi from the integumentary system.

    But I have several questions about this documentation.

    I do not see a size of lesion anywhere (just the size of the incision). And I'm confused by this "I-shaped incision ... to include entire lesion in oval."

    Was it an I-shaped incision or an oval?

    Finally the report mentions the surgical wound was closed in two layers with flaps

    If adjacent tissue transfer was used to close the wound then you do not code the excision at all, but just the 14000-14001 (or 14300 if it is >30sq cm)

    Need some clarification before you can accurately code this.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Thanks Tessa, I will query the doc, I am to a little confused on certain words, but I typed what what on operative report., so my understanding if it is a nevi, you code from integumentary system, , that does helps me alot, , sometimes I get confused on certain excisions, this does clarify, thanks, trent

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