louise Posted Mon 22nd of April, 2019 13:17:27 PM
The lesion was measured as 36mm x 28mm, a corresponding marking was created in the right supraclavicular region and increased by 10%. This was outlined with a Bard Parker 15 blade. Stevens scissors were used to dissect the full thickness skin graft from the underlying subcutaneous tissue. The dermis was removed from the full thickness skin graft epidermis. The supraclavicular region was closed with deep 4-0 vicryl sutures and a running 5-0 prolene suture. Hemostasis was obtained using bovie cautery. The skin graft was placed into position and secured using 6-0 fast gut sutures. A piece of Telfa was placed over the graft with a pressure patch. This was the conclusion of the procedure and the patient tolerated it well without complications.
SuperCoder Answered Tue 23rd of April, 2019 05:10:26 AM
Mohs is a treatment procedure for a patient with diagnosed skin cancer. As opposed to a wide excision, the goal of Mohs is to remove the entire lesion (ensure clear margins) while preserving healthy tissue, as much as possible. To accomplish this, the physician excises the lesion, then performs histology to ensure clear margins while the patient is still in surgery. The first excision of a single lesion is the first stage.
The physician will take the tissue from the first stage, map and divide the tumor into pieces, and embed each piece of tumor into an individual mounting medium, such as frozen blocks. Each of these pieces of separately embedded tissue from a single stage is a block, and the physician typically prepares a few blocks from a single stage.
Whether the physician continues to a second stage depends on the histologic findings. If the margins are clear, the procedure is complete. On the other hand, if the physician finds tumor cells in the margins of any of the tissue blocks, he will go back and remove more tissue from the patient during the same operative session. Each time the physician excises more tissue from the same, you have another stage in the Mohs procedure.
On the other hand, the full thickness skin grafts include the entire dermal layer (the epidermis and the entire thickness of the dermis). The physician removes the skin from the donor site and transfers it to the recipient bed. Both the donor and the recipient sites are then sutured closed for healing.
As per provided report, it seems that graft has been taken to cover the 36mm x 28mm size lesion, which is not the procedure of Mohs surgery. Consider it as a skin graft. So, it is suggested to check the diagnosis, intent and medical requirement of the procedure and code accordingly.