Cmcguire123
Contributor
When we are billing a stagged excision for a melanoma the complex closure is getting denied. I am billing first day 11606-58 and next day 13101-58. I have resubmitted with medical records and still denied.
Malignant Melanoma(C43.59)located on the right inferior upper back.Plan: Repair Note.Previous Surgery DetailsSurgery Type: staged excision with permanent sectionsDate: 04/02/24Repair Note:Assistants: Fatemeh Parsa LPNLocation: right inferior upper backRepair Type: Complex RepairFinal Wound Length: 7 cmPrimary Defect Dimensions and Area: 5 cm x 3.5 cm = 17.5 cm2Anesthesia: local anesthesia and local infiltration - 1% lidocaine with epinephrine (7 cc)Hemostasis: electrocauteryEstimated Blood Loss: minimalComplications: noneThe rationale for the repair was explained to the patient and consent was obtained. The risks, benefits andalternatives to therapy were discussed in detail. Specifically, the risks of infection, scarring, bleeding, prolongedwound healing, incomplete removal, allergy to anesthesia, nerve injury and recurrence were addressed. Prior tothe procedure, the treatment site was clearly identified and confirmed by the patient. All components of UniversalProtocol/PAUSE Rule completed. The area was prepped with chlorhexidine. The wound edges were debridedprior to proceeding with the closure to facilitate wound healing. Complex repair was performed to reduce tensionto enhance both functional and cosmetic results. Extensive wide undermining was performed. Extensiveundermining was performed to a distance of 5 cm (defect width perpendicular to closure is 3.5 cm) along the edgeof the entire surgical defect. The subcutaneous tissue, superficial fascia and dermis were closed with 3-0 Vicryl.Epidermal closure was achieved with 3-0 Prolene (simple interrupted). The final wound length was 7 cm.Petrolatum + dry sterile dressing were applied.
If any one has suggestion and solution please let me know.
Malignant Melanoma(C43.59)located on the right inferior upper back.Plan: Repair Note.Previous Surgery DetailsSurgery Type: staged excision with permanent sectionsDate: 04/02/24Repair Note:Assistants: Fatemeh Parsa LPNLocation: right inferior upper backRepair Type: Complex RepairFinal Wound Length: 7 cmPrimary Defect Dimensions and Area: 5 cm x 3.5 cm = 17.5 cm2Anesthesia: local anesthesia and local infiltration - 1% lidocaine with epinephrine (7 cc)Hemostasis: electrocauteryEstimated Blood Loss: minimalComplications: noneThe rationale for the repair was explained to the patient and consent was obtained. The risks, benefits andalternatives to therapy were discussed in detail. Specifically, the risks of infection, scarring, bleeding, prolongedwound healing, incomplete removal, allergy to anesthesia, nerve injury and recurrence were addressed. Prior tothe procedure, the treatment site was clearly identified and confirmed by the patient. All components of UniversalProtocol/PAUSE Rule completed. The area was prepped with chlorhexidine. The wound edges were debridedprior to proceeding with the closure to facilitate wound healing. Complex repair was performed to reduce tensionto enhance both functional and cosmetic results. Extensive wide undermining was performed. Extensiveundermining was performed to a distance of 5 cm (defect width perpendicular to closure is 3.5 cm) along the edgeof the entire surgical defect. The subcutaneous tissue, superficial fascia and dermis were closed with 3-0 Vicryl.Epidermal closure was achieved with 3-0 Prolene (simple interrupted). The final wound length was 7 cm.Petrolatum + dry sterile dressing were applied.
If any one has suggestion and solution please let me know.