PROCEDURE PERFORMED:
Wide local excision with frozen section margins of previously
biopsied positive left cheek basal cell carcinoma and local
reconstruction.

INDICATIONS FOR SURGERY:
This is a patient who initially presented to the ENT
Clinic with a left cheek skin lesion that was rapidly enlarging with
crusting and bleeding, clinically suspicious for skin cancer,
possible spindle cell carcinoma. He underwent wide local excision
in the clinic under local anesthesia with pathology results coming
back positive for a basal cell carcinoma with morpheaform features
and positive margins, deep and inferior. He was subsequently
recommended for repeat resection in the operating room with frozen
section margins. The risks, benefits, and alternatives were
presented to the patient. Questions were answered. Informed
consent was obtained.

DESCRIPTION OF OPERATION:
The patient was taken to the operating room, placed on the
operating table in supine position, and placed under IV sedation. A
surgical time-out was performed and the consents were verified. The
bed was turned 90 degrees from anesthesia for the procedure. The
patient was prepped and draped in a sterile fashion for this
procedure. Local anesthesia was used to anesthetize the area over
the previous excision site scar using 1% lidocaine with 1:100,000
concentration epinephrine. The patient was then prepped and draped
in a sterile fashion for the procedure. A marking pen was used to
mark the scar site, which measured 3 cm in length by 3 mm in width.
An ellipse was marked around the scar site and a #11 blade was used
to excise the scar through the skin and down to the subcutaneous
tissue. Undermining of the surrounding skin was performed sharply.
The deep margin of the wound to include the subcutaneous fatty
tissue was taken measuring 3 cm x 2 cm. This was sent for frozen
section. Margins on the perimeter of the excision site were also
taken superiorly and inferiorly and 2 mm in width extending the
length of the incision. Frozen section margins were sent to
pathology and came back negative with no evidence of tumor. The
wound was irrigated copiously, meticulously controlled with bipolar
cautery for bleeding and closed in a layered fashion with bilateral
advancement flaps using a 4-0 Vicryl suture for the deep dermal
suturing and a running locking 5-0 Prolene suture for the skin. The
wound was then dressed with Mastisol and half-inch micropore tape.
This completed the procedure. The patient was then taken off IV
sedation and taken to the recovery room in stable condition. He
tolerated the procedure well without complication. The patient
noted to have complete function of the marginal mandibular nerve
intraoperatively and postoperatively.

My question here is whether scar "excision" equates to scar "revision." If not, would this be a benign lesion excision since pathology came back negative? Also, do the mentioned advancement flaps warrant adjacent tissue transfer coding or should I be defaulting back to a complex repair code? Any help would be appreciated. Thank you.