Question

suspicious lesion, left forehead
post - operative diagnosis: basal cell carcinoma, forehead with clear margins
basal cell carcinoma, right cheek with clear margins
compound nevus, left nose with clear margins
epidermal nevus, left forehead with clear margins
indications for surgery: the patient is a 47 - year - old white man with a biopsy proven basal cell carcinoma of his forehead and a biopsy proven basal cell carcinoma of his right cheek. we were not quite sure of the patients location of the basal cell carcinoma of the forehead whether it was a midline lesion or lesion to the left. we felt stronger about the midline lesion, so we marked the area for elliptical excision in relaxed skin tension lines of his forehead with gross normal margins of 1 - 2 mm and i marked the lesion of the left forehead for biopsy. he also had a lesion of his left alar crease we marked for biopsy and a large basal cell carcinoma of his right cheek, which was more obvious. this was marked for elliptical excision with gross normal margins of 2 - 3 mm in the relaxed skin tension lines of his face. i also drew a possible rhomboid flap that we would use if the wound became larger. he observed all these margins in the mirror, so he could understand the surgery and agree on the locations, and we proceeded.
description of procedure: all four areas were infiltrated with local anesthetic. the face was prepped and draped in sterile fashion. i excised the lesion of the forehead measuring 6 mm and right cheek measuring 1.3 cm as i had drawn them and sent in for frozen section. the biopsies were taken of the left forehead and left nose using a 2 - mm punch, and these wounds were closed with 6 - 0 prolene. meticulous hemostasis was achieved of those wounds using bovie cautery. i closed the cheek wound first. defects were created at each end of the wound to facilitate primary closure and because of this i considered a complex repair and the wound was closed in layers using 4 - 0 monocryl, 5 - 0 monocryl and 6 - 0 prolene, with total measurement of 2.1 cm. the forehead wound was closed in layers using 5 - 0 monocryl and 6 - 0 prolene, with total measurement of 1.0 cm. loupe magnification was used and the patient tolerated the procedure well.
what icd - 10 - cm codes are reported?
c44.202, c44.40, d22.23, d22.39
c44.319, d04.39, d48.5, d22.39
c44.319, d22.39
c44.202, c44.309, d48.5, d49.2

Explanation:

The patient has basal cell carcinomas on the forehead and right - cheek, a compound nevus on the left nose, and an epidermal nevus on the left forehead. C44.202 is for basal cell carcinoma of the skin of the head and neck, other specified sites (forehead), C44.40 for basal cell carcinoma of the skin of the face, other parts of face (right cheek), D22.23 for compound nevus of nose (left nose), and D22.39 for other epidermal nevi of head and neck (left forehead).

Answer:

C. C44.202, C44.40, D22.23, D22.39