# skin lesions



## Ksumansky (Jun 29, 2010)

I was wondering how someone else would code this case.  

Pre-op/Post op diagnosis: Left periauricular and right eye lesions, Hypertrophic scar with granulomatous inflammation consistent with previous procedure (basal cell carcinoma).

Procedure: 
After consent was obtained the patient was brought into the operating room.  After local 1:100,000 was infiltrated in the tissue and an appropriate time of 10 minutes was awaited, loca excision of the periauricular area was done.  After hemostatsis was obtained wide undermining was necessary for closure to be accomplished.  Closure was accomplished with deep 5-0 vicryl, superficial 5-0 nylon.

Next attention was directed towards the right eye lesion, where excision was done through skin and subcutaneous tissue.  After this was done advancement flaps were elevated and inset into postion with deep 5-0 vicryl, superficial 6-0 nylon.  The patient tolerated the procedure well and was transferred to the recovery room in stable condition.

The doc coded it as 14060 for the eye lesion dx: 701.4 and 11642-59, 13152-59 with dx 173.2 for the periauricular lesion.  

I would love to hear your opinion on this case.  Thanks in advance!


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## muthershyp (Jun 29, 2010)

This would be difficult to code as is because:

--14060 is used for the eyelid but the location is not stated as the actual lid; I would be inclined to use 14040.  

--11642-59, 13152-59 are codes which require measurements which aren't provided.  

--The way the diagnosis is stated, I would take it that both lesions were BCC.

Just my take.......

Carol Summers, CPC, CPCD


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## Ksumansky (Jun 29, 2010)

Sorry...measurements for the periauricular area are 1.8 lesion, 3.5 closure.


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## muthershyp (Jun 29, 2010)

173.3 BCC face

13132 - 59 (complex closure)
11642 - 59 (malignant excision)

I think your physician is correct


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## ERINM (Jun 29, 2010)

Ksumansky said:


> I was wondering how someone else would code this case.
> 
> Pre-op/Post op diagnosis: Left periauricular and right eye lesions, Hypertrophic scar with granulomatous inflammation consistent with previous procedure (basal cell carcinoma).
> 
> ...


In our office we wait until the pathology report comes back before coding the excision. This is to reduce "rework" if the report comes back as benign and we sent malignant codes to insurance. 
I would disagree with the use of the complex closure, the documentation says"wide undermining" but it would be better documentation to say"complicated closure" or "extensive undermining" Again, just how we do it at our office. 
There are no measurements for the Advancement Flap for the eye. The dx for the eye lesion is Keloid Scar, but the documentation doesn't actually say"keloid" Our payers in Washington State are very strict and when treating a "true keloid" as they call it, it must be clearly documented.
I would love feedback on my response, from anyone!!!


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