# adjacent tissue transfer??



## BFAITHFUL (Sep 1, 2009)

I have a note stating patient has basal cell carcinoma of left upper lip & left cheek, dr. wants to bill excision & repair code, but I feel its 14060 for rotation to the lip? Your help is appreciated!

patient first had a 3cm x 1.7cm resection of upper lip and lower cheek to the base of left nose, the specimen itself was immediately tagged for orientation and sent for pathology. The pathology revealed that the medial aspect of the upper lip was completely free of disease. However, the multifocal lesion had extended up into the cheek and rquired additional treatment. The patient then had an additional 1cm resected in a pishaped fashion and this was also tagged and oriented. the specimen itself was revealed to have no residual disease. With this noted, the patient had a complete degloving in the left cheek. A rotation of left cheek to the upper lip and excision of some skin so that the nose would sit back in its normal position. When this was done, the patient then had a closure with multiple sutures. Progressive decreasing the dead space with 4-0 Vicryls, sewing the subq tissue to the underlying muscles and then at the edge of the upper lip securing this with 4-0 Vicryl and 5-0 Vicryl. patient then had skin closed with 7-0 nylon.


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