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codedog

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doc office booked this as 26115 and 21011 but i think its more integumentary codes 11623-hand and forehead 11643
path report did come back as squamous cell carcinoma on both. Am I on the right path ?or is doc office corret ?

26115

PREOPERATIVE DIAGNOSES: Left hand mass and right forehead mass.

POSTOPERATIVE DIAGNOSES: Left hand mass and right forehead mass

PROCEDURE PERFORMED: Excision of left hand mass and right forehead mass.

ASSISTANT: Gehr.

OPERATIVE PROCEDURE: The patient was transported to the operating room and placed on the operating table in a supine position. MAC anesthesia was utilized. The left hand and right forehead were prepped and draped in a sterile fashion. The hand was infiltrated with 1% Xylocaine plain. An elliptical incision was made to encompass the lesion. Once this was excised, bleeding was controlled. The hand was infiltrated with 1% Xylocaine and elliptical incision was made. The wound was then closed with interrupted 3-0 nylon. Attention was then turned to the forehead where this was infiltrated with 1% Xylocaine with epinephrine. An elliptical incision was made there as well. The wound was closed on the forehead with 4-0 nylon. Blood loss during the procedure was minimal. The patient tolerated the procedure. He was taken to the recovery room in stable condition.
 
I wouldn't use 11623 and 11643- no where in the procedure note does it give the diameter excised... (lesion diameter plus the most narrow margins required equals the excised diameter- I think you may be getting confused with the 3-0 nylon and 4-0 nylon is a surgical dressing the docs use when suturing the wound) unless the sizes are specified in the path report you have. Otherwise, I would down code these to 11620 and 11640- I'm on the same path as you. The report says 'lesion' not tumor-which are the codes they came up with and that leads me to skin- and since the path report says it was cancer- I would code it as malignant too. Hope this helps!
 
I tend to agree with you. 26115 involves tumors excised from a resected area and layered closure which I do not see this in the documentation. Also, the physician description of the procedure closely matches the description in Coders' Desk Reference Procedures of 11620-11646 which states "the physician makes a full-thickness incision through the skin, usually in an elliptical shape around and under the lesion." Hope this helps.
 
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