16.  A tissue expander is inserted in the forehead with 8 injections at subsequent office visits.  In a second operation, you excise a 2.5-cm lesion from the nasal tip, do a forehead flap with the expanded skin, and remove the expander. At stage three, you divide that forehead flap and inset the flap.  Code these.

Answer:
Stage I:
11960 for insertion of tissue expander for other than breast including subsequent expansion (8 injections included).

Stage II:
11443-58 (if benign) or 11643-58 (if malignant) for excision of lesion on nose 2.1-3.0 cm with modifier (09958) to indicate a staged procedure planned prospectively at initial procedure (insertion of tissue expander).
15576-99 (09951, 09958) for formation of direct pedicle with transfer to nose with modifier 09999 to indicate multiple modifiers.  09951 to indicate procedure was performed same day as excision of lesion, and 09958 to indicate that it was part of a staged procedure.
11971-99 (09951, 09958) for removal of tissue expander with modifier 09999 to indicate multiple modifiers as described above.

Stage III:
15620-58 for division and inset of forehead flap as part of staged procedure.
 

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