# Stage 2 Paramedian forehead flap



## hlth4513

I am new to ENT coding and having trouble with a STage 2 MOhs reconstruction of paramedian forehead flap to the nasal tip.

I have coded 15630-58, but I am having trouble determining how much is included in that code. Do I also code for the adjacent tissue transfers - 14040 and 14060?

I would appreciate some help. Here are details from the operative report:

" ...The flap was rotated back up to the forehead position in order to mark out the triangular flap containing eyebrow follicles. The wound in forehad was opened in linear fashion along the scar. Wide undermining was performed. The vascular pedicle bled briskly was cauterized and a suture ligation stitch was placed....the triangular flap of eyebrow and glabella was sutured into a triangular defect of the forehead skin with deep sutures...completing the closure of the new brow position. 
     The nasal flap was thinnned along the superior border of the nasal tip skin. A large portion of the subcutaneous fat was excised. The wound edges were freshened and widely undermined in order to get mobilization of both skin edges. The supratip crease was approximated with a new suture line between the flap and nasal dorsal skin. Small burrow's triangles were removed from both lateral extents of the supratip skin in order to create roundness to the tip skin and good contour of the nasal tip. Skin was closed with deep sutures...There was small wound dehiscence of the suture line along the left nostril margin at the soft tissue triangle. This was incised with a 15 blade. In order to re-excise the wound edges. The soft tissue triangle was reconstructed with a deep Monocryl suture and vertical mattress 6-0 blk nylon suture to eliminate the notching and recreate the nostril margin.
...There was an area of crusting at the superior forehead wound from the initial stage. This was debrided..."

Thanks!


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## Candice_Fenildo

CPT 15630 and the Flap codes 14040 and 14060 are not bundled within each other. My ENT coding companion states that if 15630 is performed with another seperate procedure to code the highest value first (obviously) which in this case the Flap 14040 or 14060 are the higher value codes. Hope this helps a bit.


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## hlth4513

Thanks for your help.


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