# Excision malignant lesion skin wide local of vulva or Vulvectomy?



## ealvarez113@hotmail.com (Jun 27, 2019)

My doctor says she should be able to bill for vulvectomy simple; partial 56620 On this case. I came up with Excision, malignant lesion codes 11626,11620 and layered closure 12044.  Can someone help on this? 

Pre-Op Diagnosis Code: VIN III (vulvar intraepithelial neoplasia III) D07.1

Post-Op Diagnosis Code: VIN III (vulvar intraepithelial neoplasia III) D07.1

Findings: A 1 cm acetowhite lesion was noted on the left vulva, labia minus, whcih had previously been biopsied. This was excised with a 0.5-1 cm margin, for total of a 4x2 cm vular excision. Additionally, there was acetowhite uptake in a 0.5 cm lesion at the mid perineum, and this was excised, while sparing the perianal area. Patient had a prior vulvectomy in teh perioeum and on the right vulvar already. The remainder of the vulva appeared within normal limits. The defects were closed with a layered closure.

Indications: The patient is a pleasant 56 year old female with DES in utero exposure, and history of VI and 3.  She has a history of a prior right vulvectomy. Recently, was noted to have a new left vulvar lesion which was biopsy proven to be VIN 2. She was offered a wide local excision of this lesion, and another lesion noted in the perineum. Risks, benefits, alternatives were discussed with her in detail and she agreed to proceed.

Procedure Details: The patient was taken to the operating room where she was identified both verbally and via wrist ID band. General LMA anesthesia was induced without any complications. A perioperative time was performed. Initially, 5% acetic acid was applied to the vulva, and the above findings were noted. The left labia minora over the lesion was noted to be acetowhite uptake in, and the area was marked. Initially, the vulvar was injected with quarter percent plain Marcaine, and then a scalpel was used to incise the marked area on the left vulva. Bovie cautery was then used to excise this area of the vulvar. Next, we turned our attention to the perineum, where the area was also infiltrated with quater percent plain Marcaine, and the area of interest was marked and excised with a margin. The defects on the perieum and the left vulva were now closed with layered closure with 3-0 Vicryl. There was excellent hemostasis. The patient tolerated the procdure well. She was in stable condition to the PACU next visit. All sponge, instrument, needle counts were correct x2.

Specimens:
A. Left vulva suture marks at 12 O'clock
B. Right perineum
C. Mid perineum
D. Left perineum


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## mitchellde (Jun 27, 2019)

to use the 56620 the provider would have documented one incision that would have encompassed all of the diseased area of the vulva and perianal area .  in your scenario the provide used two separate incisions for two separate areas of the vulvar/perineum region is so the requirements to call this a partial vulvectomy has not been met.


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## ealvarez113@hotmail.com (Jun 27, 2019)

Thats what I thought. So does this procedure fall under 56501, 56515 or excision codes 116..?


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