jalabergeron
Contributor
I don't code plastic surgery very often and would appreciate any help with this. The flaps and grafts are quite confusing to me. The scheduling codes include 14060, 15260, 13151. Would these be correct? Any additional codes?
Procedure: Reconstruction Facial, MOHS RECONSTRUCTION NASAL
Pre-Op Diagnosis: basal cell carcinoma of nose with complex defect involving right nasal tip and ala
Post-Op Diagnosis: basal cell carcinoma of nose
This defect was complex in the sense that it was very distal nearly at the alar margin involving both subunits of the nasal tip as well as the nasal ala. Because there was a concavity between these 2 it was felt that this would have to be reconstructed into different manners to respect the concavity as well as try and prevent retraction of the nasal margin. The defect measured 12 x 9 mm. The alar part measuring 4 x 8 mm. The skin edges were freshened to within 1 mm and hemostasis was assured. Undermining was undertaken in a supra muscular subcutaneous plane. We felt that a bilobed advancement rotational flap using Zitelli's modification was in order and this was measured marked the incisions made the flaps elevated in a supra muscular subcutaneous plane and the flaps were rotated without tension into position and secured using a layered closure. This was accomplished using 6 0 buried Vicryl sutures for the subcutaneous tissues and deep dermis while the skin edges reapproximated using interrupted 6-0 Prolene. Because slight amount of alar retraction and as planned we proceeded with a skin graft harvest. The donor site was chosen from the right preauricular region. A template was fashioned to mimic the deformity and the skin was marked for excision. It was excised down through the skin of all layers of skin and into the subcutaneous tissues. The donor site was then undermined in a subcutaneous plane and closed with a layered closure of 6 0 buried interrupted Vicryl for the subcutaneous tissues and deep dermis was skin edges reapproximated using a running 6-0 Prolene. Small amount of bacitracin ointment and a dressing was applied. The graft was prepared removing it subcutaneous tissues and the full-thickness skin was placed in position cut to fit and secured using interrupted 6-0 chromic sutures.
Procedure: Reconstruction Facial, MOHS RECONSTRUCTION NASAL
Pre-Op Diagnosis: basal cell carcinoma of nose with complex defect involving right nasal tip and ala
Post-Op Diagnosis: basal cell carcinoma of nose
This defect was complex in the sense that it was very distal nearly at the alar margin involving both subunits of the nasal tip as well as the nasal ala. Because there was a concavity between these 2 it was felt that this would have to be reconstructed into different manners to respect the concavity as well as try and prevent retraction of the nasal margin. The defect measured 12 x 9 mm. The alar part measuring 4 x 8 mm. The skin edges were freshened to within 1 mm and hemostasis was assured. Undermining was undertaken in a supra muscular subcutaneous plane. We felt that a bilobed advancement rotational flap using Zitelli's modification was in order and this was measured marked the incisions made the flaps elevated in a supra muscular subcutaneous plane and the flaps were rotated without tension into position and secured using a layered closure. This was accomplished using 6 0 buried Vicryl sutures for the subcutaneous tissues and deep dermis while the skin edges reapproximated using interrupted 6-0 Prolene. Because slight amount of alar retraction and as planned we proceeded with a skin graft harvest. The donor site was chosen from the right preauricular region. A template was fashioned to mimic the deformity and the skin was marked for excision. It was excised down through the skin of all layers of skin and into the subcutaneous tissues. The donor site was then undermined in a subcutaneous plane and closed with a layered closure of 6 0 buried interrupted Vicryl for the subcutaneous tissues and deep dermis was skin edges reapproximated using a running 6-0 Prolene. Small amount of bacitracin ointment and a dressing was applied. The graft was prepared removing it subcutaneous tissues and the full-thickness skin was placed in position cut to fit and secured using interrupted 6-0 chromic sutures.