A flap includes its local component work

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Medicare integumentary professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Operative indication

Synthetic record, September 9, 2026. An adult has a previously biopsy-confirmed basal cell carcinoma on the left cheek. The surgeon plans ordinary excision and local flap closure at that one site. No second lesion is treated and no Mohs surgery is performed.

Signed transfer report

After excision, the primary cheek defect measures 2 cm by 2 cm. The surgeon designs and incises a neighboring rotation flap, keeping its attachment intact, and carries it into the primary defect. The secondary defect measures 2 cm by 1 cm. Both defects are closed as part of the transfer.

Operative completion

The surgeon trims nonviable tissue at the same defect as needed to complete the transfer and documents final closure with good flap perfusion. No skin graft or unrelated debridement is performed. A dressing is applied and postoperative instructions are given.

Coding worksheet

A draft lists adjacent tissue transfer, same-lesion excision, debridement and repair as four separately reportable procedures. Evaluate their relationship under Medicare NCCI. The licensed-entry worksheet supplies the left-cheek location and both defect dimensions; read the full entry’s area instructions before selecting the size interval.

Your coding worksheet

Identify the comprehensive procedure from the flap technique.
Link excision, necessary debridement and closure to the same defect.
Correct the proposed separate component lines.
Take the left-cheek site and both defect measurements to the authorized entry’s area instructions.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The deliberate incision and movement of an attached adjacent flap establish tissue transfer, rather than undermining followed only by direct closure.
The excision, necessary local debridement and repair concern the same lesion and its defect. NCCI includes them in this transfer relationship.
Do not add separate procedure lines for those included components merely because the operative note describes each step. No separate graft or different-site service is documented.
The primary defect is 2 by 2 cm and the secondary defect is 2 by 1 cm, at the left cheek. Use both documented measurements as directed by the current transfer entry. Closure length is not a substitute for the required area measurement.

Reference sections: H.1–2

Practice the linked chart questions