# Advancement flap or not?



## BFAITHFUL

dr. wants to bill 116xx and 12042 which is what I'm also leaning towards, but then he confuses me especially since he also mention under procedure heading (advancement of flap closure)? 

DX: basal cell carcinoma of left postauricular mastoid area

Operation:  Wide excision and an advancement of flap closure and frozen 
section controlled.

Area measured approximately 3.5cm x 1.5cm and infiltrate of anesthesia was obtained using Xylocaine .5% with 1:200,000 epinephrine after prepping with alcohol. 

The patient was then transferred to the operating room and placed on the operating room table in a semi-reclining position and the area prepped and draped in the usual sterile manner using Betadine.

Excision of the aforementioned area was carried out with the #15 blade and cautery down to the full thickness of the skin and soft tissue to the underlying fascia and margins were marked with two different color sutures.

While awaiting the frozen section report, the skin surrounding the area going down to the neck was undermined in this plane above the fascia to release and advanced.

The advancement was carried in multiple layers of interrupted inverted simple sutures of 5-0 PDS for the soft tissue and deep dermis.  All margins free of tumor.  the final closure was with running intracuticular sutures of 5-0 nylon followed by Dermabond.


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## Cuteyr

*Advancement*

*Adjacent tissue transfer or rearrangement*
The physician transfers or rearranges adjacent tissue to repair traumatic or surgical wounds of the trunk. This includes, but is not limited to, such rearrangement procedures as Z-plasty, W-plasty, ZY-plasty, or tissue transfers such as rotational or *advancement* flaps. Report 14000 for defects that are 10 sq cm or less and 14001 for defects that are 10.1 sq cm to 30 sq cm.

Adjacent tissue transfers include excision of the defect or lesion so excision codes should not be reported additionally

Hope this will help you ....


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## FTessaBartels

*Size of flap?*

I'm not sure I'm seeing the size of the flap ... and I think this was on the neck.

Look at codes 14040-14041.  

F Tessa Bartels, CPC, CEMC


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## BFAITHFUL

thank you, it's just the usual op reports I get describes it in a clearer way, than this note does


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