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Help? Havent done this since CPC exam...

  1. Default Help? Havent done this since CPC exam...
    Medical Coding Books
    I haven't code Derm since I took the CPC exam years ago, but am now asked to review the following note. I cant remember if I need to take the largest size of the ellipse excision or if I need to multiply the dimensions of the ellipse together for each site? Thank you...



    Postoperative Diagnoses: Congenital nevus of the posterior scalp
    and congenital nevus of the right thigh.

    Names of Operations/Procedures: Excision with complex closure on
    the scalp, excision with intermediate closure on the thigh.

    Anesthesia: General with 5 ml of 0.5% Xylocaine with epinephrine
    and 4 ml of 0.25% Marcaine with epinephrine.

    Operative Indications: These congenital nevi are being resected
    to prevent deterioration into malignancy.

    Description of Operative Procedure: After informed consent was
    obtained and advised of the risks of
    bleeding, infection, that scars will ensue at the site of removal
    of these lesions, the patient was induced with general anesthesia
    uneventfully. The area of the nevus was prepped and draped in the
    usual manner on the scalp. The scalp nevus measured 16 x 16 mm,
    the ellipse 29 x 17 mm. Specimen was excised to the galea and
    submitted in its entirety for histopathologic exam. Hemostasis
    was obtained using electrocautery. Blood loss was less than 10
    ml. The wound edges were extensively undermined and the wound was
    closed in two layers using 4-0 Vicryl interrupted subcutaneous
    suture and 5-0 Prolene running cuticular suture. A standard
    pressure dressing was placed over the area and attention was
    turned to the right thigh, where a nevus measuring 9.6 mm was
    present on the skin. A curved ellipse measuring 21 x 7 mm was
    drawn around the nevus. It was excised into the fat and submitted
    in its entirety for histopathologic exam. Hemostasis was
    obtained using electrocautery and blood loss was less than 5 ml.
    The wound edges were extensively undermined and the wound closed
    in two layers using 4-0 Vicryl interrupted subcutaneous suture and
    5-0 Prolene interrupted subcuticular suture. Steri-Strips and a
    standard pressure dressing were placed over here. The patient was
    discharged to recovery in good condition. Pt will return for
    suture removal in two weeks.

  2. #2
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    Columbia, MO
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    Default
    You use the largest excised diameter. that is lesion size plus margins. Also last year they changed the rule regarding complex closures so you will have a complex closure and an intermediate clouse as well as 2 excisions.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Sorry this may be a dumb question, but what does the lesion size and margins add up to be in this example? Also, the beginning of the note stated there was intermdiate and complex closures, but in the narrative it states both needed "extensive undermining" which is considered complex closure.

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