# Malignant skin lesions question please help not sure if I billed right



## Savmorton (Apr 13, 2017)

A malignant melanoma (skin) of the face measuring 1.0 cm was excised. To ensure all the margins were free of tumor, an additional 2.0 cm was excised from both the top and bottom respectively. Intermediate closure of the resulting 5.5 cm defect was performed. 

Is it ok to bill for 11641 & 12053


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## CodingKing (Apr 13, 2017)

I'm not sure where the extra .5cm came from since 1 + 2 + 2 = 5. Also I don't believe the physician stating it was intermediate closure is sufficient. Typically the note will state the type of suture material, if it was layered, depth etc. There is nothing here to back up the decision that it's intermediate so the closure code 

11646 would be the excision since lesion plus margins are over 4cm.


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## ellzeycoding (Apr 13, 2017)

I believe the original poster was stating the length of the *repair* was 5.5cm (which is often larger than the excised lesion).

If it truly was an intermediate repair (with appropriate documentation), then 12053 would be the appropriate repair code for a repair that is 5.5cm long.

Documentation should mention the type of repair (intermediate) and that layered closure was involved.  It should also mention that superficial non-muscle fascia was involved and the medical necessity for performing the type of repair (e.g., preserve anatomy, reduce tension for cosmetic results, etc.).


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## ishtiyaq.ahmad (Jun 15, 2017)

CPTs: 11646 and 12053

Document should support layered closure or closing of deep layers of skin and subcutaneous tissue. But if physician himself mentioning that he performed intermediate closure then we can consider it as intermediate repair. So the above codes are correct for the given scenario.


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