Excision Pilonidal cyst & fistula tracts (Cleft Lift Procedure)

Does anyone do these procedures?  Our colon/rectal surgeon wants to charge an advancement flap.  I need to know if this dictation qualifies?  We as coders feel that undermining skin & de-epithelializing is not a flap & would consider this part of the closure.  I could not locate any coding info re: Cleft Lift except if flaps are done they may be charged. Buttocks were pressed medially in the safe lines were drawn out. The extent of the fistulous tract & midline pits was determined using fistula probe & marked out with skin marker. The entire extent of cyst & fistulous tracts was excised down to presacral fascia using electrocautery. The final excised lesion was 7.5 by 2.5 cm in total size. The right sided luteal skin was undermined or 6 cm laterally. A 10 French round Blake drain was brought into the wound & brought out through a separate stab incision in the right side of the superior gluteal area. This was sutured to skin. The wound was then closed in layers using 3-0 monocryl to reapproximate the subcutaneous tissues in 2 layers. Skin flap on right side was the sutured to the cut edge of the left buttock skin.  This was done using 3-0 monocryl deep dermal sutures.  Following this 3-0 prolene was used to place a series of vertical mattress sutures. The wound was closed with minimal tension & was well approximated.  Any help with this procedure would be greatly appreciated!!


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