# Help? Havent done this since CPC exam...



## renifejn (Dec 21, 2009)

I haven't code Derm since I took the CPC exam years ago, but am now asked to review the following note.  I cant remember if I need to take the largest size of the ellipse excision or if I need to multiply the dimensions of the ellipse together for each site?  Thank you...



Postoperative Diagnoses:   Congenital nevus of the posterior scalp
and congenital nevus of the right thigh.    

Names of Operations/Procedures:  Excision with complex closure on  
the scalp, excision with intermediate closure on the thigh.    

Anesthesia:  General with 5 ml of 0.5% Xylocaine with epinephrine  
and 4 ml of 0.25% Marcaine with epinephrine.   

Operative Indications:  These congenital nevi are being resected  
to prevent deterioration into malignancy.   

Description of Operative Procedure:  After informed consent was  
obtained and advised of the risks of  
bleeding, infection, that scars will ensue at the site of removal  
of these lesions, the patient was induced with general anesthesia  
uneventfully.  The area of the nevus was prepped and draped in the
usual manner on the scalp.  The scalp nevus measured 16 x 16 mm,  
the ellipse 29 x 17 mm.  Specimen was excised to the galea and  
submitted in its entirety for histopathologic exam.  Hemostasis  
was obtained using electrocautery.  Blood loss was less than 10  
ml.  The wound edges were extensively undermined and the wound was
closed in two layers using 4-0 Vicryl interrupted subcutaneous  
suture and 5-0 Prolene running cuticular suture.  A standard  
pressure dressing was placed over the area and attention was  
turned to the right thigh, where a nevus measuring 9.6 mm was  
present on the skin.  A curved ellipse measuring 21 x 7 mm was  
drawn around the nevus.  It was excised into the fat and submitted
in its entirety for histopathologic exam.  Hemostasis was  
obtained using electrocautery and blood loss was less than 5 ml.   
The wound edges were extensively undermined and the wound closed  
in two layers using 4-0 Vicryl interrupted subcutaneous suture and
5-0 Prolene interrupted subcuticular suture.  Steri-Strips and a  
standard pressure dressing were placed over here.  The patient was
discharged to recovery in good condition.  Pt will return for  
suture removal in two weeks.


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## mitchellde (Dec 21, 2009)

You use the largest excised diameter.  that is lesion size plus margins.  Also last year they changed the rule regarding complex closures so you will have a complex closure and an intermediate clouse as well as 2 excisions.


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## renifejn (Dec 21, 2009)

Sorry this may be a dumb question, but what does the lesion size and margins add up to be in this example?  Also, the beginning of the note stated there was intermdiate and complex closures, but in the narrative it states both needed "extensive undermining" which is considered complex closure.


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