General Surgery Coding Alert

Question: Our surgeon performed an excision of a 0.5 x 0.6 cm basal cell carcinoma on the patient’s nose with 0.1 cm margins extending into the subcutaneous fat, creating a 0.8 x 0.7 cm defect. The surgeon closed the defect with a bilobed flap. How should we code this?

Georgia Subscriber

Answer: A bilobed flap is an adjacent tissue transfer. The area of the defect is 0.8 x 0.7 cm, which is 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: Malignant lesion excision codes include simple closure or allow additional reporting for intermediate or complex closure, but CPT® guidelines state, “For excision performed in conjunction with adjacent tissue transfer, report only the adjacent tissue transfer code.”