# Outpatient surgical center-I need help



## PragnaJ (Nov 5, 2008)

I need help with CPT code. Code I have selected, code 14040 but I am not sure about the total size of the flap was done  Thankyou in advance.

POSTOPERATIVE DIAGNOSIS:	Melanoma in situ of the right lateral cheek. 172.3

PROCEDURE PERFORMED:	Wide excision of melanoma in situ from right lateral cheek with rotation advancement flap reconstruction. CPT-14300,( As per AMA guideline malignant lesion excision code 11643 is not separately reportable  with code 14300.Please check payer policy.
CLINIC SUMMARY:  This is a 72-year-old gentleman who presents with a biopsy-proven melanoma in situ of the right lateral cheek in the temporal sideburn area.  The patient was brought for wider excision today and reconstruction.  The procedure is as follows. 

DESCRIPTON OF PROCEDURE:  The patient was brought into the operating room; and after a satisfactory state of intravenous sedation was achieved, his face was prepped with Betadine and draped.  The residual lesion measured exactly 1 cm.  A radial border was then circumscribed using 7.5-mm radial margin.  This resulted in excisional defect of 2.4-cm diameter.  This area was widely infiltrated with lidocaine 0.5% with 1:200, 000 of epinephrine.  

Excision was then performed deeply all through the subcutaneous tissue to the underlying SMAS of the lateral cheek area.  The superior margin was marked with a suture for pathologic orientation.  An anticipated dog-ear was now excised running in a medial direction and a suture was placed for orientation at the far apex or 3'o clock at the non-tumor side.  This extension was 2.5 cm in length.  

A flap was then created by incising, extending from the 9' o clock portion of the defect towards the preauricular crease directly downwards in the preauricular crease and down just in front of the ear lobule.  This incision was 5 cm long.  With this incision, a subcutaneous flap was then dissected relatively deeply over an area of 5 cm x 5 cm. 

Hemostasis was meticulously achieved with bipolar electrocautery.  The flap was then rotated in a clockwise upwards direction and secured with multiple sutures of 4-0 chromic in the deeper dermis.  Some redundant skin most laterally was trimmed to fit into the defect appropriately and then the skin was repaired with interrupted and running suture of 6-0 nylon.  The site was then covered with Adaptic and sterile gauze secured with tape and a circumferential wrap with kling.  The patient was then brought to the recovery room having tolerated the procedure well


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## FTessaBartels (Nov 6, 2008)

*14041*

I would choose 14041 because the surgeon states ...
a subcutaneous flap was then dissected relatively deeply over an area of *5 cm x 5 cm.*   (emphasis added by FTB)

5cm x 5cm equals *25 sq cm*. 

F Tessa Bartels, CPC, CPC-E/M


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