# help with repair codes



## BFAITHFUL (Aug 9, 2009)

Well, here I go again, I have 2 op notes, the first doctor dictates excision of cyst with complex closure, I think its intermediate?? 
the second excision of neck lesion with intermediate repair? & this one I think it could be complex? 


after IV sedation given, the excision of the skin was performed, dissection using blunt and sharp dissection was performed around the mass. It was removed in its entirety and sent to pathology, hemostasis was achieved, the large defect measured 2cm x 2cm x2cm deep was then closed in layers using a PDS suture to close the dead space below followed by a subdermal 3-0 PDS suture and a running 5-0 Prolene suture in the subcuticular fashion. 


lesion on neck was excised in a elliptical excision of the skin, the skin excision was done, so that the skin flaps were raised. With this done the patient then had the subcutaneous tissue mobilized and the previous area of the thyroid excision was noted, this was then included but the excision of the strap muscles avoided with careful dissection, the mass itself was larger than 3.5cm, there is no evidence of any adhesion to the previous thyroid. Once the patient had this completely done, meticulous hemostasis obtained with electrocautery, irrigation of the wound was done and the patient first had the strap muscles re-coapted with multiple sutures of 4-0 Vicryl. The fat was then repaired with 5-0 Vicryl. the dermis was closed with 5-0 Vicryl and the patient had the subcuticular closure with 5-0 Prolene and 7-0 nylon. Path. report states subq. adipose tissue 4.5x1.5x2.0cm


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## daniel (Sep 1, 2009)

after IV sedation given, the excision of the skin was performed, dissection using blunt and sharp dissection was performed around the mass. It was removed in its entirety and sent to pathology, hemostasis was achieved, the large defect measured 2cm x 2cm x2cm deep was then closed in layers using a PDS suture to close the dead space below followed by a subdermal 3-0 PDS suture and a running 5-0 Prolene suture in the subcuticular fashion. 
                     (I think this one was a layer closure, because it says so in 
                      documentation)






lesion on neck was excised in a elliptical excision of the skin, the skin excision was done, so that the skin flaps were raised. With this done the patient then had the subcutaneous tissue mobilized and the previous area of the thyroid excision was noted, this was then included but the excision of the strap muscles avoided with careful dissection, the mass itself was larger than 3.5cm, there is no evidence of any adhesion to the previous thyroid. Once the patient had this completely done, meticulous hemostasis obtained with electrocautery, irrigation of the wound was done and the patient first had the strap muscles re-coapted with multiple sutures of 4-0 Vicryl. The fat was then repaired with 5-0 Vicryl. the dermis was closed with 5-0 Vicryl and the patient had the subcuticular closure with 5-0 Prolene and 7-0 nylon. Path. report states subq. adipose tissue 4.5x1.5x2.0cm 
                   (I'd go with complex closure on this one)


Daniel, CPC


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