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Question: The surgeon carried out a removal of a basal cell carcinoma, measuring 0.5 x 0.6 cm, on the patient’s nose. The excision included 0.1 cm margins that reached into the subcutaneous fat, resulting in a 0.8 x 0.7 cm wound. The wound was then closed using a bilobed flap. How should I code this?

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Answer: An adjacent tissue transfer, also known as a bilobed flap, was used. The defect’s dimensions were 0.8 x 0.7 cm, equating to a total area of 5.6 square cm. That means you should report code 14060 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less) for this case.

Although the correct malignant lesion excision code for a 0.8 cm lesion (0.6 + 2 x 0.1 = 0.8) on the nose is 11641 (Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm), you should not report this code with 14060.

Here’s why: Codes for the excision of malignant lesions incorporate simple closure and permit additional reporting for intermediate or complex closure. However, according to CPT^® guidelines, if an excision is performed alongside an adjacent tissue transfer, only the code for the adjacent tissue transfer should be reported.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC