midnight1995
Networker
The below follow Operative report - CPT codes billed 15240 & 15760
1.) Aetna is denying 15240 stating the below does not support along with reduce services - Any help will be great need a second set of eyes
Procedure:
1.) left auricular composite graft
2.0 left postauricular full thickness skin graft to cover a 00.8 x 0.7 cm through and through left nasal alar defect
Examination of the wound revealed a 0.8 x 0.7 cm through and through defect of the left nasal ala. Using an Iris scissors the wound edges were debrided and adequate health bleeding skin edges were observed. This was followed by circumferential subcutaneous discretion of the surrounding tissue with iris scissors to mobilize the local tissue and create and medical and lateral tunnel for placement of the composite graft. The would was determined to be too large for local closure. The decision was made that it would be in the patients best interest for wound closure to use a left sided auricular cartilage graft and full thickness skin graft for the internal defect.
Attention was turned to the auricular composite graft harvest, a 2.5 cm elliptical incision was marked behind the left concha to harvest an auricular composite graft to support the nasal ala and close the external defect. once marking was completed, 3 cc of 1$ lidocaine with 1:100,00 epinephrine was injected into the marked out area. once the patient was sufficiently anesthetized, the incision was completed with a #15 bladed. once incision was made trough the conchal cartilage, careful dissection of the perichondrium off the anterior aspect of the auricular cartilage was completed. the composite graft was than mobilized, removed, and put on the back table. hemostasis was achieved with electrocautery and the donor site would was closed with a running locking 5-0 nylon suture.
The extra skin on the composite graft was removed, It measured 0.9 x0.9 cm. the full thickness skin graft was then sutured to the internal aspect of the nasal defect with 4-0 chromic sutures.
Next, the auricular composite graft was than placed into the left nasal alar defect. the cartilage (measuring 2.3 cm) was extended into the medical and lateral tunnels. the skin aspect of the composite graft was sutured to the existing would with 5-0 nylons sutures providing closure of the defect.
The wounds
1.) Aetna is denying 15240 stating the below does not support along with reduce services - Any help will be great need a second set of eyes
Procedure:
1.) left auricular composite graft
2.0 left postauricular full thickness skin graft to cover a 00.8 x 0.7 cm through and through left nasal alar defect
Examination of the wound revealed a 0.8 x 0.7 cm through and through defect of the left nasal ala. Using an Iris scissors the wound edges were debrided and adequate health bleeding skin edges were observed. This was followed by circumferential subcutaneous discretion of the surrounding tissue with iris scissors to mobilize the local tissue and create and medical and lateral tunnel for placement of the composite graft. The would was determined to be too large for local closure. The decision was made that it would be in the patients best interest for wound closure to use a left sided auricular cartilage graft and full thickness skin graft for the internal defect.
Attention was turned to the auricular composite graft harvest, a 2.5 cm elliptical incision was marked behind the left concha to harvest an auricular composite graft to support the nasal ala and close the external defect. once marking was completed, 3 cc of 1$ lidocaine with 1:100,00 epinephrine was injected into the marked out area. once the patient was sufficiently anesthetized, the incision was completed with a #15 bladed. once incision was made trough the conchal cartilage, careful dissection of the perichondrium off the anterior aspect of the auricular cartilage was completed. the composite graft was than mobilized, removed, and put on the back table. hemostasis was achieved with electrocautery and the donor site would was closed with a running locking 5-0 nylon suture.
The extra skin on the composite graft was removed, It measured 0.9 x0.9 cm. the full thickness skin graft was then sutured to the internal aspect of the nasal defect with 4-0 chromic sutures.
Next, the auricular composite graft was than placed into the left nasal alar defect. the cartilage (measuring 2.3 cm) was extended into the medical and lateral tunnels. the skin aspect of the composite graft was sutured to the existing would with 5-0 nylons sutures providing closure of the defect.
The wounds
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