# Full Thickness Skin Graft Closure



## dyoungberg

Dr performed the following on a patient:

_PREOP DIAGNOSIS:   BCC RIGHT SIDE OF NOSE 
POSTOP DIAGNOSIS:  SAME

PROCEDURE:  RESECTION OF BCC, RIGHT SIDE OF NOSE, WITH FULL THICKNESS SKIN GRAFT CLOSURE AND ROTATIONAL ADVANCEMENT FLAP CLOSURE OF DONOR SITE   

COMPLICATIONS:   NONE 

OPERATIVE FINDINGS: There was a tattooed 1.2 cm in diameter shallow erythematous scar overlying the alar crease about midway between the dorsum and the lateral alar margin.  

PROCEDURE:  Under IV sedation, the patient was prepped and draped in a sterile manner in order to give good exposure to the head and neck. The area surrounding the lesion and the left lip-cheek crease area were infiltrated with a total of 10 cc Lidocaine 1% w/epinephrine 1:100,000. A fusiform 4.0 x 1.4 cm segment of full thickness skin was excised, encompassing the lesion. The adjacent skin was undermined. A similar sized segment of skin from the lip-cheek crease on the ipsilateral side was excised, tailored to size, and inserted into the defect. It was sutured in place with 5-0 Rapide skin sutures and a bolster of Adaptic, followed by a cotton ball moistened with Betadine using 5-0 Prolene stay sutures. The donor site was closed in a rotational advancement flap fashion. The adjacent skin was undermined, rotated, and advanced to fill the defect. The subcutaneous tissue was closed with 4-0 Monocryl and the skin with 5-0 Rapide. Polysporin ointment was applied. The patient awakened and returned to the recovery room in good condition. There were no complications. 

Frozen section histoanalysis revealed margins free of tumor. _

When submitting this to Medicare I coded this as 11646 for the lesion excision, 15260 for the repair and 14040 for rotational flap repair of the donor site.  Medicare paid 15260 & 14040 but denied 11646 as procedure not paid separately.  Was I wrong in coding 11646?  Any thoughts or advice on this?

Thanks very much!

Debbie Youngberg
CPC-A


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## DeeCPC

What modifiers were used?


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## dyoungberg

*Full Thickness Skin Graft*

Dee,

This went to Medicare with no modifiers.  Upon looking at the op note again I think I should have added a 59 to 14040.

Debbie


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## jholt12

Hi,
 Code 14040 includes any excisions you have done whether it is malignant or bengin.


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## dyoungberg

*Full thickness skin graft closure*

14040 wasn't really an excision of a lesion.  The defect was created when a graft was taken to repair the nose lesion excision.  The doctor then did a rotational advancement flap repair of the donor site.


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## dyoungberg

11646 was the excision of nose lesion, 15260 was the skin graft to close the lesion excision.  Then the Dr did rotational flap repair of the _donor _site instead of direct closure.  I don't understand why 11646 & 15260 can't be billed together and paid.  14040 is a separate procedure entirely.  Am I not thinking about this correctly?


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