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Dermal Scar Excision

I am needing help with this procedure for scar excision.

Reason for appointment:
The patient is here for re-excision of 2 skin cancer lesions. The small lesion on the left side of her nose was previously removed and the pathology showed it to be a BCC with the peripheral and deep margins involved. We also removed a suspicious lesion from her left shin and this was reported to be "atypical melanocytic proliferation compatible with evolving malignant melanoma in situ, margins appear narrowly clear by less that 0.1 cm in examined sections."

Procedures:
Informed consent obtained. Prep usual sterile fashion. Anesthesia 1 mL of lidocaine on the nose, and 5 mL of lidocaine with epinephrine on the shin. A full thickness skin elliptical incision was made with a #15 blade scalpel on the left side of the nose measuring 1.5 mm in width and 3 mm in length. This wound was closed with 5-0 clear prolene in simple interrupted fashion and dressed with triple antibiotic ointment. A full thickness skin elliptical incision was made with a #15 blade scalpel on the left shin containing the scar from previous excision and a margin or normal appearing skin measuring 1.0 cm in width and 2.3 cm in length. This wound was closed with 3-0 Nylon in vertical mattress fashion and dressed with triple antibiotic ointment and a Bandaid.

Pathology report:
Part A: shin – L SHIN
Part B: nose – LEFT NOSE

Part A: Dermal scar and biopsy site changes. No evidence of malignancy. – L90.5
Part B: Basal Cell Carcinoma, Nodular type. – C44.311

My question is regarding the scar. The only codes I can find is for complex repair (of scar revision), but I don’t think the note matches that description. Does anybody know what would be more appropriate for this?

Thank you!

Medical Billing and Coding Forum

Medical Grade Facial Cleansers Prove Vital in Acne Scar Prevention

I know what you’re thinking; of course a facial cleanser is going to have benefits for acne sufferers.  And a cleanser so effective it is considered medical grade, it makes even more sense, but would you ever imagine that facial cleansers can actually aid in the removal long term acne?  In recent clinical studies therapeutic facial cleansers have exhibited additional benefits other than the standard detoxification, exfoliation and gentle cleansing.  These advanced, state of the art facial cleansers have proven to display actual therapeutic treatment for acne scars.  The author examines how therapeutic facial cleansers may provide much more value to our skin care routine than was originally believed. 

As most of us know, acne is often caused by an accumulation of dead skin cells, too many toxins, and other impurities within the skin.  Following this logic it makes quite a bit of sense that a facial cleanser that would remove the dead skin cells, wipe away impurities, oils and dirt would have tremendous benefit for people with acne.  But it is not the obvious benefits that have scientists and dermatologists around the world taking a much closer look at these cutting edge facial cleansers.

What has generated all of the publicity about these therapeutic facial cleansers is some of the additional ingredients that they contain that have proven to be very effective in a number of ways with consistent use.  Therapeutic facial cleanses, by definition contain ingredients that provide therapeutic treatment to any number of symptoms of conditions of the skin.  As a result of this combination of ingredients, scientists have found that these cleansers actually provide significant improvement in the long term treatment for people who suffer from acne scars.

Experts say that there are a few reasons that these facial cleansers can be so effective in the long term therapeutic treatment of your skin.  Some say that the inclusion of the active ingredient of a tangerine oil is the key.  Tangerine oil allows for deeper and more rapid absorption of other active ingredients that come in contact with the skin.  This means that the ingredients in the cleanser as well as any other product that you may use as a part of your routine would be more effective.  Obviously, this is a very big deal for wrinkle treatments and other anti aging pursuits, but it has also proven extremely helpful with the treatment of acne scars.  Others, however, claim that the reason for the acne scar results is the unique blend of anti inflammatory ingredients in the cleanser.  Using balanced and effective anti inflammatory ingredients like Chamomile Extract sooth the inflamed and damaged tissue that results in acne scars.  Scientists believe that by using an advanced therapeutic facial cleanser twice daily you are able to maintain healthier skin, reduce the visibility of acne scars, and help prevent the onset of any future scars.

This is obviously very big news for the skin care industry, a facial cleanser actually delivering long term, therapeutic benefits to acne scar sufferers.  As we learn more about both our skin and the best treatments for it, the more advanced and effective the products we use every day will become.  That is certainly the case with facial cleansers and we have seen major improvement with wrinkle creams over the years.  You can never know what will be next, but for now we can be thankful that we have found effective, affordable, long term treatment for many conditions of the skin, including acne scars.

Mark Robbins is a reviewer of the best facial cleansers on the market, with particular attention paid to those that can help with the treatment of acne and acne scars. Many of his readers have shared stories like this one, http://www.acnescarscream.net on how some treatments have helped them in their battle with acne scars.

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Cesarean-Section Scar Coding in ICD-10

When coding a previous or current cesarean-section (C-section) scar, Z98.891 History of uterine scar from previous surgery is appropriate when the mother is receiving antepartum care and has had a previous C-section delivery. You must confirm that the mother is receiving antepartum care that is considered routine, and there are (thus far) no complications with […]
AAPC Knowledge Center

Scar revision

HELP!! Is this enough for Complex repair 13120 or do need to ask for an addendum?

The left knee was then opened with #10 blade. A Subvastus approach performed. There was extensive adhesions and scar tissue within the medial and lateral gutters and the suprapatellar pouch. We excised this with cautery. Once we did this we had improved flexion to 115 degrees. We then cleaned out around the PCL and improved flexion to 125 degrees. I then assessed extension, which was full. I released the tourniquet, got good hemostasis and injected the local cocktail around the knee. I then wash with pulsatile lavage containing Rifampin. A Hemovac drain was placed. The wound was then closed with #2 Quill, 2-0 Vicryl and staples.

Medical Billing and Coding Forum

Scar excision

Having a little difficulty coding the following:

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.

Medical Billing and Coding Forum

Acne scar revision

HI I’m new to plastic surgery coding.

I’m looking for help with a CPT code for Revision of acne scar on left cheek. I have been looking at CPT codes 11441 and 12051. Then I also saw for a "Scar Revision" to use 13160. The procedure note states: The scar was carefully excised parallel to the resting skin tension lines and repaired with 5-0 Vicryl in the deep and subq and 6-0 Prolene and plastic repair of the skin.

Any help is greatly appreciated

Thank you
Kristy

Medical Billing and Coding Forum

CPT code for Excision of Abd Wall Mass (Keloid Scar) s/p Cesarean Section & Hyst

Hi there, I am new to this forum :)
I am trying to get the best CPT code for the following description "Suspect cutaneous nerve entrapment in knot of keloid tissue s/p cesarean section and total laparoscopic hysterectomy, Pfannestiel incision; approximately size of scar tissue is 1 cm in left lateral edge. Will be an open approach for superficial wound exploration."
I’m thinking 11401 for wide local excision of cesarean scar but have used 49203 in the past. Any advise would be greatly appreciated. Thanks! Jenette

Medical Billing and Coding Forum