# how to code wide excision melanoma upper extremity



## ksmcarthur

How would you code the following:

The right arm was prepped and draped in standard fashion. Elliptical incision was made surrounding the pervious biopsy site, deepened using electrocautery until the muscle fascia was identified. The specimen was removed from the fascia and this was then oriented with sutures and the total excision was 6cm x 2.5cm x 4cm. The wound was irrigated and hemostasis was noted. Using 3-0 Vicryl, the deep tissues were reapproximated and then a nylon was placed in an interrupted fashion to reapproximate the skin edges. The wound was cleaned and dried, sterile dressing was applied. The pt tolerated the procedure well and was transported to recovery room in good condition.


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## mitchellde

go to the CPT book and find a malignant excision code for extremity of 6cm size   also a code for the intermediate repair of 6cm for extremity.  Your dx code is the melanoma of the arm


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## lindacoder

I would check out 24079 - radical resection of tumor, soft tissue upper arm or elbow area, more that 5 cm


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## Mklaubauf

Please review the section instructions on page 64 under Excision - Malignant Lesions in the CPT book.   It states, "excision (including simple closure) of malignant lesions of skin(eg, basal cell carcinoma, squamous cell carcinoma, melanoma) includes local anesthesia."

The reason is these types of carcinoma arise from the dermis.   So code from this section with layer closure is necessary.    (Check Medicare's policy to see if you can add the layer closure. 
Hope this helps,
Marci


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