General Surgery Coding Alert

Question: Our surgeon performed a complex repair for a scar revision a year after the patient had a procedure for a facial neoplasm resection. We billed for the procedure using 13132 and diagnosis code C43.39. Why might we have received a denial?

Texas subscriber

Answer: The misstep was using the ICD-10-CM code for the cancer as the principal diagnosis. When a surgeon performs reconstruction or scar revision surgery following a healed neoplasm resection, you should code the reconstruction as the reason for the test.

In this case, instead of reporting the diagnosis as C43.39 (Malignant melanoma of other parts of face), you should use Z42.8 (Encounter for other plastic and reconstructive surgery following medical procedure or healed injury). Because ICD-10-CM indicates this is a principal diagnosis, you will always list it first when the reconstruction is performed as a follow-up to a prior medical procedure. You should list all other ICD-10-CM codes after Z42.8. This tells the payer that this is a medically necessary procedure.

Assuming the documentation matches the location, type, and size of the repair represented by the code you mention, 13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm), using that code should not be the problem.