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Rotation Flap Repair of lateral eyebrow for excision of BCC

Terry Posted Tue 22nd of July, 2014 13:41:27 PM

My dermatologist has excised a BCC lesion on the right lateral eyebrow. Would the correct CPT code be 14040 or 14060? See notes below. Thanks.

Procedure done per the operative note:
Location: right lateral eyebrow
Preop Size: 1.2 cm
Margins: 0.2 cm
Total Excised Diameter: 1.6 cm
Procedure: Excision - Fusiform
Anesthesia: local infiltration-1% lidocaine with epinephrine and a 1:10 solution of
8.4% sodium bicarbonate(4 cc)
Estimated Blood Loss: minimal
Complications: none
Repair Type: Intermediate
Final Wound Length: 3.1 cm

Procedure: The area was prepped with Hibiclens and draped in the usual fashion. A fusiform excision was performed, on the right lateral eyebrow, with a 15 blade. The margin was drawn around the clinically apparent lesion. A fusiform shape was then drawn on the skin incorporating the lesion and margins. Incisions were then made along these lines to the appropriate tissue plane and the lesion was
extirpated. The lesion was excised to the layer of the adipose tissue. The defect edges were debeveled with a #15 scalpel blade. Given the location of the defect, shape of the defect and the proximity to free margins a rotation flap was deemed most appropriate. Using a sterile surgical marker, an appropriate rotation flap was drawn incorporating the defect and placing the expected incisions within the relaxed skin tension lines where possible. The area thus outlined was incised deep to adipose tissue with a #15 scalpel blade. The skin margins were undermined to an appropriate distance in all directions utilizing iris scissors. Intermediate layered repair was performed to preserve normal anatomy and to reduce tension to skin to allow closure. Undermining was performed with blunt dissection. Hemostasis was achieved with lectrocautery. The dermal sutures were 5-0 Vicryl. Epidermal closure was achieved with 6-0 Prolene (running and simple interrupted). The final wound length was 3.1 cm. A waterproof dressing was applied. Suture removal in 7 days.

SuperCoder Answered Wed 23rd of July, 2014 05:56:05 AM

Since, the provider has performed the procedure on eyebrow, code 14040 would be most appropriate.

14040 represent 'Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less'.

Thanks !!

Terry Posted Wed 23rd of July, 2014 07:19:49 AM

Thanks so much!

SuperCoder Answered Wed 23rd of July, 2014 08:51:44 AM

You are welcome.

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