# Excision Mass Axilla/ Skin Flaps



## Trendale (Aug 3, 2011)

Hello,

Can someone offer their expertise on the followng sugery, I'm not sure if I should charge for skin flap closure (13120)  All he said in the report was marcaine and epinephrine was infiltrated into skin flaps. Please let me know if 19120 as well as 13120 is correct for the following surgery, Thanks!

DESCRIPTION OF OPERATION:  The patient was transported to the
operating room and placed in the supine position.  General anesthesia
was administered via the LMA device.  The right axilla was prepped and
draped in usual sterile fashion.  The circulating nurse called a
surgical timeout.  All members of the operative team were in agreement
with that process.  Marcaine 0.5% with epinephrine was infiltrated at
the inferior aspect of the right axillary hairline.  A transverse skin
incision was made.  Sharp dissection was carried down through the skin
and subcutaneous tissues.  Hemostasis was strict and achieved with
electrocoagulation.  A large deep mass was excised from the right
axilla.  This resembled a large lymph node.  Prior to removal of the
mass, the vascular supply was occluded with clips prior to division.
Once removed, the specimen was submitted for pathology.  The wound was
irrigated with saline.  Hemostasis was strict.  No other abnormalities
or injuries were noted.  The subcutaneous tissues were approximated
using interrupted sutures of 3-0 Vicryl.  Marcaine 0.5% with
epinephrine was also infiltrated into the skin flaps.  The skin was
closed using a running subcuticular suture of 4-0 Vicryl.  Dermabond
and sterile dressing were applied.  At the completion of the
procedure, all sponge, needle and instrument counts were correct.
Estimated blood loss was 10 mL.  The patient tolerated the procedure
well and was transported to the PACU in stable condition.


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## FTessaBartels (Aug 3, 2011)

*Not 13120*

I don't see documentation of the creation of skin flaps at all.  I would just code the excision.

Hope that helps.

F Tessa Bartels,CPC, CEMC


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## Trendale (Aug 4, 2011)

*Thanks Ftessabartels, now I have a question on DX*

The doctor went deep into the axilla to remove a large mass, in which he stated resembled a large lymph node. The path report later confimed "lymph node with melanoma". Myself and another coder was having a discussion as to whether what would be the appropriate code. 172.5 vs 202.94? I originally coded this as 172.5 with 785.6, but since the pathologist did not go into detail regarding the lymph node ( inflammed or enlarged), I figured I should leave off the 785.6 and code 172.5 or 202.94.  The reason why I am debating 202.94 is because the instructions in the Icd-9 book under melanoma says " internal sites should be coded to malignant neoplasm of those sites", which leads us to 202.94, because the lymph node was deep under the skin into the lymph node. Thanks 
in advance!




This question was also posted in the Dx Coding category as well.


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