# Wide excision malignant melanoma



## smcbroom

I need some help in regards to the code(s) for this procedure.  The MD office scheduled as 14040 w/172.2 as the ICD-9 but I'm not convinced that these are the correct codes.  Or would you use 172.8?  Also, because of the undermining done, would you code it as a an intermediate or complex repair instead?  Any thoughts are appreciated.  Obviously I work for an ASC.  Here is the report....

PREOPERATIVE DIAGNOSIS:

Clark's level II malignant melanoma Breslow 0.35 mm malignant melanoma of right retrolobular neck status post previous biopsy


POSTOPERATIVE DIAGNOSIS:

Clark's level II malignant melanoma Breslow 0.35 mm malignant melanoma of right retrolobular neck status post previous biopsy.

OPERATION:

Wide excision of malignant melanoma.

ANESTHESIA:

General oropharyngeal inhalation

DESCRIPTION OF PROCEDURE:

Under satisfactory general anesthesia, the margins were marked out with approximately 1.5 cm on either side of the somewhat longitudinal lesion at the closest dimension.  There was an area of surrounding and beneath the lesion was injected with 1% Xylocaine with 1:100,000 epinephrine totalling approximately 12 cc.  Standard prep and drape were then done.

The premarked ellipse was excised and taken down to the superficial portion of the parotid and through the muscle fascia posteriorly and into the SMAS fascia anteriorly.  Specimen was removed and oriented with sutures, short-short being anterior and long-short superior retrolobular.  It was sent to pathology for permanent section diagnosis.  Hemostasis was obtained.  The wound was undermined in the superficial SMAS layer anteriorly for approximately 1 cm, inferiorly the same, and posteriorly at the level of the mastoid fascia.  The SMAS was approximated to the mastoid fascia with interrupted sutures of 3‑0 Vicryl knots inverted, so that the exposed portion of parotid could be resurfaced.  The more superficial layer was accomplished with interrupted sutures of same knots inverted.  The inferior dog‑ear was taken out.  The skin was repaired with interrupted sutures of 6‑0 nylon.  The retrolobular wound was covered by extending incision around the anterior aspect of the earlobe.  The tissues were brought around posteriorly and inset with deep sutures of 3‑0 Vicryl and sutures of interrupted 6‑0 nylon in the skin.

Upon completion, the wound was cleansed.  Occlusive dressing was applied and secured loosely with tape.  He was awakened, extubated, and returned to the PAR in satisfactory condition

No intravenous medications other than required for anesthesia.  Blood loss was negligible.  There were no intraoperative complications.


Thank you for your help!
Susan


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## mbort

Susan, I would consider 21556 or 21557, take a peek and see what you think.  I feel this is much more than 14040.

Mary, CPC, COSC


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## smcbroom

Mary,
I don't know why I didn't even think to look at those.  I will take a further look to see if one of those will work.   I guess I wasn't sure because of where it's at by the earlobe/neck area.

Thanks!
Susan


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