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Posted By Maria on 09-23-2019, 10:26:51 in Ob-Gyn
Hello Melanie,

Welcome Back!!

Would this be considered DX PP complications even though delivery 4 years ago?

Would this be a simple genital repair?

Also on skin tag? If it required a suture would that be considered an excision? Not simple skin tag removal?

Part of H&P She had a vaginal delivery 4 years ago and since then she has been having pain and the labia has been bothersome, getting caught in her underpants. She wants it removed.

Pre-op Diagnosis: 
1. G2P2 with prior labial laceration- detachment of the R labia minora
2. Perineal skin tag
3. Symptomatic - dyspareunia
4. Vulvar pain.
Post-op Diagnosis: Same

Procedure Details: The patient was taken to the operating room and placed in the dorsal supine position with a leftward tilt. She was prepped and draped in the normal sterile fashion. The R labia minora had been examined and marked in the pre op area. It was attached proximally, but the distal aspect of this labia minora was not attached at all to the patients skin. (4-5cm of tissue) ( This was due to failure of a prior repair)The area was examined again and all the appropriate markings were made. A longitudinal incision was made using a knife and sharp dissection along the bottom and edge of the labia minora (left), excision the skin . Bleeding was controlled with a electrocautery and pressure. Meticulously placed interrupted sutures of 4-0 monocryl were used to bring the edges back together anatomically. One suture line was placed on the medial aspect of the labia minora and one on the outer (later) aspect of the labia minora. Arista was sprayed over the oozing surfaces and gel foam was also placed to ensure hemostasis. Repeated visual exams were done to ensure symmetry. Pressure was applied over the area.
Attention was now turned towards the perineal region and the skin tag was identified. There was an excess outpouching of skin on perineum toward the rectum. There was also a small hemorrhoid, but this removal did not continue to the area of the hemorrhoid. Markings were made around the skin tag in an elliptical shape and was incised using a knife. The cut edges were brought together with 3- vicryl in an interrupted manner. A rectal exam was done at the end to ensure patency of the anal canal. Excellent hemostasis noted. (pt had also marked this area previously)
The patient tolerated the procedure well. Excellent hemostasis noted and pressure applied with ice.
All sponge and instrument counts were correct x 2. She was taken to the recovery room in stable condition and will be discharged home after recovery with pain medication and stool softener, with instructions to follow up in Days.

Comments (1)
Posted By Melanie Witt on 09-23-2019, 17:29:15
First, you would not use the skin tag code for this (11200) because removal for this code is via dessication and scissors. He did an actual excision and therefore you will go with the benign lesion removal code 11420-11426 so you need to know the margins for the excision if you want to bill more than 11420 for this perineal tissue. And as this was different than the repair of the labia (which appears to mean that he removed the 4-5cm piece that was not attached) so I think you can bill 11426 for the labia repair which was simple.
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