KBean2018
Guru
Hello, I am needing advice on coding. I am coming up with 14020, 12051. Any thoughts would be appreciated 
Thank you
Pre-op Diagnosis:
Malignant melanoma of right lower extremity including hip (HCC) [C43.71]
Suspicious nevus right lower eyelid
Post-op Diagnosis:
same
Procedure:
Closure right lower eyelid wound 18 x 12 mm and right arm wound 48 x 50 mm
1. Right forearm ulcerated melanoma presenting for wide local excision A second suspicious nevus was noted on her right lower eyelid and her lid check junction. I am asked to assist with closure of both defects intraoperatively.
Finally he excised the right lower lid/cheek nevus with 2 mm margins. I then came to the operating room to close the wounds.
The right forearm has a nearly circular 4.8 x 5.0 cm defect in the radial dorsal aspect down to the muscle fascia. Due to her age and the laxity of her skin I determine that with some extensive undermining I will be able to close the defect primarily without significant tension. Therefore in a subcutaneous plane, using cautery I widely undermining her skin flaps medially and laterally. Care is taken to avoid any superficial veins or sensory nerves. Hemostasis is achieved with cautery. The wound is irrigated. The dermis is reapproximated with 2.0 interrupted buried vicryl sutures. Standing cutaneous cones are excised from both the proximal and distal edges of the closure to allow for a flat incision line. The skin is then closed with 4.0 nylon mattress sutures. This is dressed with gauze and an ace wrap.
Attention is then turned to the 1.8 x 1.2 cm right lid/cheek junction defect. In order to limit the risk of ectropion, I undermined the cheek to bring the loose midface up rather than pull down on her lower lid. The cheek was mobilized in the plane above the SMAS muscle to avoid any facial nerve branches. Cautery was used for hemostasis. The wound was irrigated with saline. Once adequately mobilized 3-0 vicryl was used int he dermis to fix the cheek flap superiorly to the lid defect. 4-0 vicryl was used in the subcuticular layer to close the skin. Demabond was applied.
Thank youPre-op Diagnosis:
Malignant melanoma of right lower extremity including hip (HCC) [C43.71]
Suspicious nevus right lower eyelid
Post-op Diagnosis:
same
Procedure:
Closure right lower eyelid wound 18 x 12 mm and right arm wound 48 x 50 mm
1. Right forearm ulcerated melanoma presenting for wide local excision A second suspicious nevus was noted on her right lower eyelid and her lid check junction. I am asked to assist with closure of both defects intraoperatively.
Finally he excised the right lower lid/cheek nevus with 2 mm margins. I then came to the operating room to close the wounds.
The right forearm has a nearly circular 4.8 x 5.0 cm defect in the radial dorsal aspect down to the muscle fascia. Due to her age and the laxity of her skin I determine that with some extensive undermining I will be able to close the defect primarily without significant tension. Therefore in a subcutaneous plane, using cautery I widely undermining her skin flaps medially and laterally. Care is taken to avoid any superficial veins or sensory nerves. Hemostasis is achieved with cautery. The wound is irrigated. The dermis is reapproximated with 2.0 interrupted buried vicryl sutures. Standing cutaneous cones are excised from both the proximal and distal edges of the closure to allow for a flat incision line. The skin is then closed with 4.0 nylon mattress sutures. This is dressed with gauze and an ace wrap.
Attention is then turned to the 1.8 x 1.2 cm right lid/cheek junction defect. In order to limit the risk of ectropion, I undermined the cheek to bring the loose midface up rather than pull down on her lower lid. The cheek was mobilized in the plane above the SMAS muscle to avoid any facial nerve branches. Cautery was used for hemostasis. The wound was irrigated with saline. Once adequately mobilized 3-0 vicryl was used int he dermis to fix the cheek flap superiorly to the lid defect. 4-0 vicryl was used in the subcuticular layer to close the skin. Demabond was applied.