# Medicare Denial for adjacent tissue transfer



## tholcomb (Nov 17, 2011)

For this claim below Medicare is denying the second flap to the Rt medial cheek 14040-mod. 59 due to the fact that states service already processed for payment for the first flap for the Rt lateral cheek what gives??? Any advise, Thank you,  TH

The lesion was removed by Mohs micrographic surgery, fresh-tissue technique in 5 stages.  The final post-operative wound size measured 2 centimeters and at a depth extended into deep subcutaneous. The site of the lesion was right lateral cheek. The wound has been allowed to heal by rhombic flap.  
 the 2 cm defect of the right lateral cheek was scrubbed with Hibiclens
The total area of the flap was 8 sq. cm

The final post-operative wound size measured 1.5 centimeters and at a depth extended into deep subcutaneous.  The site of the lesion was right medial cheek.  The wound has been allowed to heal by rhombic flap. 
1.5 cm defect of the right medial cheek was scrubbed with Hibiclens. 
The total area of the flap was 8 sq. cm.


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## weshelman (Nov 18, 2011)

Appeal with operative notes. Be sure to explain and/or highlight the difference in the areas.


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