luisa Posted Sun 20th of August, 2017 11:27:08 AM
Physician thinks that we can not code the complex closures and scar revision if its the same anatomical site.
1. Subperiosteal resuspension of the left brow
2. Excision of facial scars of the forehead 7 cm, glabella 3.5 cm, right upper eyelid 3 cm, right cheek 3.7 cm, Left lower eyelid 5.5 cm, left cheek 2.3 and 2.7 cm
3. Complex closure of the right upper eyelid 3 cm
4. Complex closure of the left lower eyelid 5.5 cm
5. Complex closure of the glabella and forehead 10 cm
6. Complex closure of the left cheek 5 cm
He coded CPT codes 13132,13133,13152,14041,1446
The incision was made and carried to the level of the periosteum. Subperiosteal dissection was carried to the left supraorbital rim. Cautery was used to release the periosteum at the level of the orbital rim. This allowed sufficient laxity to elevated the brow to a symmetric position compared to the right side. A 1.0 mm wire passing drill but was used to create unicortical holes at The desired position of the reposition free margin of the forehead skin. 5 such holes were made to facilitate repositioning and closure. 3-0 PDS was place through the drill holes to reposition the brow into symmetric position. A second row of 5-0 PDS was used for dermal approximation. Interrupted 5-0 Plain gut half buried horizontal mattress sutures were placed to approximate the skin graft of the scalp to the forehead skin. 4-0 PDS was used to approximate the frontalis muscle in the midline incision. 5-0 PDS was used for deep dermal closure and a running 5-0 Prolene subcuticular suture was place in the vertical closure.
For the remaining scars the eyelids and cheeks, the scars were marked and injected with 1/2% Lidocaine with 1:100,000 epinephrine. The scars were excised in the subcutaneous plane. The surrounding tissues were undermined in the subcutaneous plane in order to bridge the defects and allow for tension free closure. Hemostasis was obtained using the cautery, and hemostasis was rechecked following irrigation. The wounds were then closed in layers by approximating the deep dermal tissues with interrupted 5-0 PDS. The superficial layer was reapproximated with 5-0 running subcuticular Prolene. Dermabond was applied. EBL 10 ml.
SuperCoder Answered Mon 21st of August, 2017 01:36:53 AM
AAE does not provide coding for operative reports and chart notes. SuperCoder offers SuperCoding on Demand (SOD) (http://www.supercoder.com/coding-answers/coding-on-demand) for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail email@example.com for more information.