For an accurate response to surgical coding questions, please post the scrubbed operative note.
I do have some hints for you ...
FIRST: I'm hoping you have documentation from the physician as to the measurement of the lesion. "Excised diameter" refers to the PHYSICIAN's pre-procedure measurement of the lesion plus minimal margin necessary for complete removal. The size of the wound cannot be used as the size of the lesion; the wound may (and usually is) larger.
If all I had was what you stated: excised a 3-cm SCC from the temporal scalp - I would use 11643 for the excision.
SECOND: CPT guidelines tell us that when a primary procedure requires skin graft for closure you do NOT code 15002-15005; instead you use the primary procedure (in this case CPT 1164x).
THIRD: Read all the guidelines for grafts carefully. Do them one at a time and decide if they apply to your scenario.
FOURTH: NOTE that grafts are coded using sq cm measurements AND thickness of graft. Both these measurements/ characteristics have to be spelled out in the documentation in order to code.
Hope that helps.
F Tessa Bartels, CPC, CEMC
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