# Wide excision of nevus with layer closure



## codedog (Nov 30, 2009)

DX - Right  hip congenital nevus 
 Procedure : Wide excision of nevus with multiple closure. 
      The area had been mark in the preoperative holding area . It was on the hip. IT  was prepped and draped in normal fashion. A marking pen was used to ensure we have 1.5 2.0 cm mark all the way around. a 10cc of 1% lidocaine with epinephrine was used to inject in subdermal area . A large 12-15 cm I-SHAPED incision was made to include entire lesion in oval. This was done all way down to the subcutaneous fat. A specimen was removed and sent to Pathlogy. Excellent hemostasis was noted to be obtained. The wound was closed in two layers with flaps with 3-0 and 4=0 vicryl in subcuticular fashion. It was noted to come together excellently without evidence of tension. Steri-STRIPS   and sterille dressings were placed. 

path report came back as a congenital compound nevus- 216.7
 my question is this 
 Do i code 27047-with dx code 216.7
or do i code 11426 with layer closure 
 which one would you choose, and why ?


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## FTessaBartels (Dec 1, 2009)

*More questions for you*

First, in general we code excision of nevi from the integumentary system.

But I have several questions about *this *documentation.

I do not see a size of lesion anywhere (just the size of the incision).  And I'm confused by this "*I-shaped incision ... to include entire lesion in oval*."

Was it an I-shaped incision or an oval?

Finally the report mentions the surgical wound was closed in two layers with *flaps* 

If adjacent tissue transfer was used to close the wound then you do not code the excision at all, but just the 14000-14001 (or 14300 if it is >30sq cm)

Need some clarification before you can accurately code this. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## codedog (Dec 1, 2009)

Thanks Tessa,  I will query the doc, I am to a little confused on certain words, but I typed what what on operative report., so my understanding if it  is a nevi, you code from integumentary system, , that  does helps  me alot, , sometimes I  get confused on certain excisions, this does  clarify, thanks, trent


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