# Wide excision of melanoma/ Complex repair?



## Trendale (Jun 6, 2011)

Hi,
I am trying to figure out if I coded this surgery correctly. I believe complex repair should be coded, given skin flaps were involved. Also, dictation states he went through skin and sub q tissue all the way to the fascia.I am not sure I am in the right code series, given that he went to the fascia.( I was thinking dictation has to state subfascia/within the muscle, to give it a 2000 series, could be wrong) I don't do these every day, so sometimes I forget, and have to refresh on the guidelines. I would gladly appreciate if anyone can provide their expertise on the following surgery: ( Thanks in advance)

A skin marker was used to mark adequate margins around the lesion on the left lateral chest at a minimum of 1cm on all sides of the lesion.  After adequate block was obtained, skin incisions were made. The dissection was carried through the skin and subcutaneous tissues. Hemostastasis was strict and achieved with electrocoagulation. Dissection was carried through the adipose tissue all the way to the fascia. The lesion was excised in it's entirety. The total diameter of the excised specimen was 3.8 cm. The total length of the specimen was 12cm. A suture was used to mark the 12 o clock margin, and the specimen was submitted for hispathopathology. Skin flaps were developed using electrocautery. Hemostasis was also strict and achieved with electrocautery. Wound irrigated and closed in layers. The deeper layers were closed using interrupted sutures 3-oVicryl.

The following are the codes I coded:
13101
11604-51
172.5
As far as the size of the lesion. he gave 2 measurements in the report. According to my knowledge, I went by the statement , " the total diameter of the excised lesion was 3.8 cm."  Is that correct?
A far as the closure, I did not give it the 14000 code series, because dictation did not mention additional incisions, in which undermining alone would not constitute adjacent tissue transfer, per guideline. Is that correct? His dictation on the repair is not always detailed, but I guess dictationg skin flaps was developed using electrocautery is sufficient documenation to code a complex repair?


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## FTessaBartels (Jun 8, 2011)

*19120*

In general, once you are beneath the dermis (i.e. into subq) you are coding from musculoskeletal section.   BUT ...  chest/breast tissue is still in the itegumentary system.

Did you look at 19120?

Hope that helps.

F Tessa Bartels, CPC, CEMC


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