nlbarnes
Expert
Hello - 15574 is for the forehead, cheeks, chin, mouth, neck, axillae... 15576 is for the nose.
Is this coded by recipient area or the donor site? The guideline in the CPT manual leads me to believe that it's the recipient area. The provider coded 15574 & 15504.
PROCEDURE:
1. The right paramedian forehead flap to the nasal tip.
2. Open wound site preparation.
A template of the defect was created with a Telfa material. The distance from the nasal tip to the eyebrow was mannered at 5.5 cm. At that moment the template of the defect was applied at 5.5 cm above the medial border of the left eyebrow and a paramedian flap was planned according the Xylocaine 1% containing epinephrine 1/100,000 was used to infiltrated the first and second branches of the trigeminal nerve as well as block anesthesia to the nasal columella base as well as the bilateral alar base in addition to general anesthesia to the forehead area reaching the hairline from the level of the eyebrows. A total of 11 mL was used.
The paramedian flap was then created with a 15 blade through skin subcutaneous tissue and periosteum. The flap was then elevated from superior to inferior towards the eyebrow area whereby it was turned from the patient's right to the patient's left side making sure that the feeding artery and the right supratrochlear artery will be preserved. Hemostasis will be achieved successfully with low wattage bipolar cautery.
At that moment, the edges of the open wound were trimmed in order to receive successfully the rotated flap. This way the open wound site preparation was completed.
In order to relieve the tension of the suture line at the anterior border of the nasal tip defect, the paramedian forehead gap was closed using 3-0 Vicryl material for the deep layer and 5-0 Monocryl material for the skin layer.
At that moment the paramedian flap tip was to size and shape and fixated in place at the nasal tip defect using intermittent suture of 5-0 Vicryl material for the deep layer and intermittent suture of 5-0 Monocryl material for the skin layer. A Surgicel piece immersed in bacitracin was applied to the wrap around the exposed flesh of the interposed pedicle flap.
The circulation into the flap appears to be very healthy looking.
Is this coded by recipient area or the donor site? The guideline in the CPT manual leads me to believe that it's the recipient area. The provider coded 15574 & 15504.
PROCEDURE:
1. The right paramedian forehead flap to the nasal tip.
2. Open wound site preparation.
A template of the defect was created with a Telfa material. The distance from the nasal tip to the eyebrow was mannered at 5.5 cm. At that moment the template of the defect was applied at 5.5 cm above the medial border of the left eyebrow and a paramedian flap was planned according the Xylocaine 1% containing epinephrine 1/100,000 was used to infiltrated the first and second branches of the trigeminal nerve as well as block anesthesia to the nasal columella base as well as the bilateral alar base in addition to general anesthesia to the forehead area reaching the hairline from the level of the eyebrows. A total of 11 mL was used.
The paramedian flap was then created with a 15 blade through skin subcutaneous tissue and periosteum. The flap was then elevated from superior to inferior towards the eyebrow area whereby it was turned from the patient's right to the patient's left side making sure that the feeding artery and the right supratrochlear artery will be preserved. Hemostasis will be achieved successfully with low wattage bipolar cautery.
At that moment, the edges of the open wound were trimmed in order to receive successfully the rotated flap. This way the open wound site preparation was completed.
In order to relieve the tension of the suture line at the anterior border of the nasal tip defect, the paramedian forehead gap was closed using 3-0 Vicryl material for the deep layer and 5-0 Monocryl material for the skin layer.
At that moment the paramedian flap tip was to size and shape and fixated in place at the nasal tip defect using intermittent suture of 5-0 Vicryl material for the deep layer and intermittent suture of 5-0 Monocryl material for the skin layer. A Surgicel piece immersed in bacitracin was applied to the wrap around the exposed flesh of the interposed pedicle flap.
The circulation into the flap appears to be very healthy looking.