1. Lesions are measured across the widest diameter PLUS minimal margin necessary for complete excision. The way I read this documentation the physician is reporting the size of the INCISION (not the size of the lesion). The incision is necessarily LARGER than the lesion itself. In any case if the lesion were reported as 4cm x 2cm you would code it as 4cm.
2. Was this done all in one operative session? i.e. he excised, waited for path to come back, re-excised and then closed with a flap? If YES ... the advancement flap INCLUDE removal of the lesion, so you only code the flap.
If it was TWO sessions. You code the lesion excision based on size of lesion in operation # 1. Then when he came back to the OR to excise more tissue and complete the flap you code ONLY the advancement flap - and don't forget your modifier for staged procedure!
Hope that helps.
F Tessa Bartels, CPC, CEMC
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