Wound check following Mohs surgery with secondary intention healing

[TSheehan84]

What diagnosis would be appropriate to use? Our Mohs surgeon performed the surgery and is seeing the patient every two weeks for a wound check. I'm thinking this is an aftercare code Z48.817. My provider insists he can use the original skin cancer diagnosis code for the follow up wound check due to the surgical site is still healing by secondary intention. Wouldn't the follow up wound checks be considered history?

 

[thomas7331]

I agree with you on this. The whole purpose of doing a Mohs surgery in the first place is to be able to confirm that the malignancy is completely removed during the procedure.

Per the ICD-10 chapter 2 guidelines on coding of neoplasms, "When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy at that site, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy."

So unless for some reason the Mohs procedure was not successful, or unless there is continued treatment directed at the cancer itself or other active lesions during the follow up visit, the provider should not be selecting a cancer diagnosis code for those visits. If the only purpose of the encounter is wound care and the cancer is no longer be present and/or being treated, the visit would be coded with an aftercare code with a history of skin cancer code as the secondary diagnosis.