We are having an extremely hard time with Aetna paying for a complex repair - we bill 11402 Diagnosis code D22.71, Aetna will pay the 11402 , but reject the 13121 even after office notes are uploaded. We have tweaked our documentation to list the layers included in the closure, can anyone provide guidance on this? Recommendations on documentation requirements etc? Here is an example of how our documentation is worded using a test patient: NO PHI is included
Excision Procedure Detail:
Indication: remove atypical cells
The surgical set up was completed in the standard clean fashion.
18 cc of 1% lidocaine with epinephrine and bicarbonate injected into the site. An additional 6cc of marcaine injected, patient confirmed numbing achieved.
Method: Excision was performed using a #15 Bard-Parker Carbon Steel Surgical Blade
Pre-Operative Lesion Sizing: Preoperative size of the lesion was 0.6cm (length) and 0.6 cm ( Width). A margin of 0.3 cm was taken on all sides of the lesion.
Post-Operative Sizing: Postoperative size of wound, including margins, was 1.2cm. Undermining size 3.0
Closure Type: Complex Repair
Pathology Accession Reference #: 24-2859-D
– Complex Repair Procedure Details:
Consideration was then given to the optimal means of repair. In order to minimize tension and to achieve optimal functional and healing results, a complex repair was deemed most appropriate. With this in mind, the surgical wound was extensively and widely undermined to minimize tension and obtain adequate support during the healing process necessary for a reasonable scar. Undermining was greater than or equal to the maximum width of defect measured perpendicular to the closure line at 3.0cm. Buried absorbable sutures were used to close the subcutaneous and dermal components of the defect. The defect was then closed in layers using 4-0 Vicryl dermal-deep subcutaneous sutures with a quantity of 7 . The cutaneous layer was closed and margins approximated using 3-0 Nylon cutaneous sutures totaling 10. Length of Repair measures 4.0 cm . A sterile pressure dressing was then applied to the wound.
Estimated blood loss: minimal.
Pre-operative size: 0.6 cm
Margins: 0.3 cm
Final length of wound or sum of wound lengths: 4.0 cm .
Estimated blood loss: minimal
Complications: None
Condition of patient after surgery: good
Excision Procedure Detail:
Indication: remove atypical cells
The surgical set up was completed in the standard clean fashion.
18 cc of 1% lidocaine with epinephrine and bicarbonate injected into the site. An additional 6cc of marcaine injected, patient confirmed numbing achieved.
Method: Excision was performed using a #15 Bard-Parker Carbon Steel Surgical Blade
Pre-Operative Lesion Sizing: Preoperative size of the lesion was 0.6cm (length) and 0.6 cm ( Width). A margin of 0.3 cm was taken on all sides of the lesion.
Post-Operative Sizing: Postoperative size of wound, including margins, was 1.2cm. Undermining size 3.0
Closure Type: Complex Repair
Pathology Accession Reference #: 24-2859-D
– Complex Repair Procedure Details:
Consideration was then given to the optimal means of repair. In order to minimize tension and to achieve optimal functional and healing results, a complex repair was deemed most appropriate. With this in mind, the surgical wound was extensively and widely undermined to minimize tension and obtain adequate support during the healing process necessary for a reasonable scar. Undermining was greater than or equal to the maximum width of defect measured perpendicular to the closure line at 3.0cm. Buried absorbable sutures were used to close the subcutaneous and dermal components of the defect. The defect was then closed in layers using 4-0 Vicryl dermal-deep subcutaneous sutures with a quantity of 7 . The cutaneous layer was closed and margins approximated using 3-0 Nylon cutaneous sutures totaling 10. Length of Repair measures 4.0 cm . A sterile pressure dressing was then applied to the wound.
Estimated blood loss: minimal.
Pre-operative size: 0.6 cm
Margins: 0.3 cm
Final length of wound or sum of wound lengths: 4.0 cm .
Estimated blood loss: minimal
Complications: None
Condition of patient after surgery: good