My physcian performed surgery on a patient for Wide local excision of Merkel cell carcinoma of the right forhead with layered closure and full thickness skin graft reconstruction. He coded the following;

11646 Ex malignant w/simple closure
13152 repair complex
15240 FTSG

And all of them with the Dx of Merkel Cell carcinoma 209.31

Medicare is saying that 209.31 does not justify procedure 11646.

I am not a full time coder and the doctors do most of their own coding and i can't seem to figure out what to do. Medicare paid the repair and the graft.