I am coding repair of a facial defect by adjacent tissue transfer. The defect involves both the lip and cheek area. It is an adjacent tissue transfer of the lip skin laterally and the cheek skin medially to close a 2.5 cm melolabial fold defect.
The doctor wants to code two adjacent tissue transfer codes(14060 and 14040), but I thought we were limited to a single ATT code per defect.
The operative report includes:
" The defect was found to be 2.5 cm at its greatest dimension from the nasal labial fold to the inferior edge of the wound along the melolabial fold. The defect was skin only and did not involve the patient's orbicularis oris muscle. The patient was able to smile and purse her lips normally. The skin was widely undermined around the upper lip. A back cut was made along the right nostril sill through the junction of the columella and upper lip at the nasolabial angle. An additional back cut was made along the cheek alar junction to advance the cheek medially. The lateral edge of the incision through the cheek was also widely undermined the rounded border at the melolabial fold near the modiolus. The rounded border near the modiolus was turned into a 30 degree angle by excising Burow's triangle. The cheek and lip were able to be reapproximated and sutured with deep Monocryl sutures. The skin was closed with 6-0 black nylon suture in a running locking fashion along the melolabial fold. A running subcutaneous Monocryl suture reapproximated the nasal sill to the upper lip and the nasal ala to the cheek and upper lip junction. This was then closed with simple interrupted 6-0 black nylon sutures."
Thanks!
The doctor wants to code two adjacent tissue transfer codes(14060 and 14040), but I thought we were limited to a single ATT code per defect.
The operative report includes:
" The defect was found to be 2.5 cm at its greatest dimension from the nasal labial fold to the inferior edge of the wound along the melolabial fold. The defect was skin only and did not involve the patient's orbicularis oris muscle. The patient was able to smile and purse her lips normally. The skin was widely undermined around the upper lip. A back cut was made along the right nostril sill through the junction of the columella and upper lip at the nasolabial angle. An additional back cut was made along the cheek alar junction to advance the cheek medially. The lateral edge of the incision through the cheek was also widely undermined the rounded border at the melolabial fold near the modiolus. The rounded border near the modiolus was turned into a 30 degree angle by excising Burow's triangle. The cheek and lip were able to be reapproximated and sutured with deep Monocryl sutures. The skin was closed with 6-0 black nylon suture in a running locking fashion along the melolabial fold. A running subcutaneous Monocryl suture reapproximated the nasal sill to the upper lip and the nasal ala to the cheek and upper lip junction. This was then closed with simple interrupted 6-0 black nylon sutures."
Thanks!
