Chapter 15 / Skin and subcutaneous tissue

When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account.

Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection.

The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.


15.1 - Lesions of skin

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



H5680 Excision of pressure sore excluding repair Intermediate £250.00 £220.00 Show arrow
S0410 Wide excision of sweat glands - bilateral axillae Intermediate £450.00 £220.00 Show arrow
S0520 Microscopically controlled excision of lesion of skin or subcutaneous tissue (Mohs micrographic surgery) with immediate reconstruction Xmajor £850.00 £275.00 Show arrow
S0602 Primary excision of malignant lesion - head and neck Intermediate £300.00 £165.00 Show arrow
S0603 Primary excision of malignant lesion - trunk and limbs Intermediate £300.00 £165.00 Show arrow
S0604 Secondary excision of malignant lesion - head and neck Intermediate £300.00 £165.00 Show arrow
S0605 Secondary excision of malignant lesion - trunk and limbs Intermediate £300.00 £165.00 Show arrow
S0521 Microscopically controlled excision of lesion of skin or subcutaneous tissue (Mohs micrographic surgery) without reconstruction Major £700.00 £275.00 Show arrow
S0606 Photodynamic therapy to malignant lesion of skin - up to three Intermediate £250.00 £0.00 Show arrow
S0607 Photodynamic therapy to malignant lesion of skin - four or more Major £250.00 £0.00 Show arrow
S0608 Sentinel lymph node biopsy for melanoma Intermediate £300.00 £165.00 Show arrow
S0632* Excision of lesion of skin or subcutaneous tissue - up to three, Head & Neck (excluding lipoma) Minor £140.00 £110.00 Show arrow
S0633* Excision of lesion of skin or subcutaneous tissue - up to three, Trunk & Limbs (excluding lipoma) Minor £140.00 £110.00 Show arrow
S0642* Excision of lesion of skin or subcutaneous tissue - four or more, Head & Neck (excluding lipoma) Intermediate £250.00 £110.00 Show arrow
S0643* Excision of lesion of skin or subcutaneous tissue - four or more, Trunk & Limbs (excluding lipoma) Intermediate £250.00 £110.00 Show arrow
S0651 Removal of benign lesion on trunk or limbs less than 10 cm in diameter or on scalp less than 5cm in diameter (excluding lipoma) Minor £140.00 £110.00 Show arrow
S0652 Removal of benign lesion on trunk or limbs greater than 10 cm in diameter or on scalp greater than 5 cm in diameter (excluding lipoma) Intermediate £210.00 £110.00 Show arrow
S0653* Removal of benign lesion in muscle or deeper tissue (excluding lipoma) Intermediate £210.00 £110.00 Show arrow
S0654 Removal of benign lesion on head and neck (excluding scalp) which is closed by primary closure or advancement flap (excluding lipoma) Intermediate £210.00 £110.00 Show arrow
S0655 Removal of benign lesion on head and neck requiring flap closure (excluding advancement flap) (excluding lipoma) Intermediate £210.00 £110.00 Show arrow
S0656* Removal of lipoma Intermediate £210.00 £110.00 Show arrow
S0820 Curettage/cryotherapy of lesions of skin including cauterisation - four or more Intermediate £200.00 £110.00 Show arrow
S0922 Laser destruction of lesion(s) of skin - up to 25cm² in area Minor £150.00 £0.00 Show arrow
S0923 Laser destruction of lesion(s) of skin - over 25cm² in area Minor £200.00 £0.00 Show arrow
S0940 Photodynamic therapy to non malignant lesions of skin Intermediate £250.00 £0.00 Show arrow
S1420 Shave biopsy of lesion of skin Minor £100.00 £100.00 Show arrow
S4480 Removal of foreign body in deeper tissue Intermediate £300.00 £165.00 Show arrow
S4720 Drainage of lesion of skin, including abscess Minor £100.00 £100.00 Show arrow
S4740 Drainage of large subcutaneous abscess/haematoma Minor £200.00 £165.00 Show arrow
S6400 Excision of nail bed (Zadik's) (including anaesthetic) Intermediate £200.00 £165.00 Show arrow
S7010 Wedge excision or avulsion of nail (including chemical ablation of nail bed) Minor £150.00 £110.00 Show arrow

15.2 - Repair

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



S4182 Debridement and primary suture of wound with involvement of deeper tissue - Head and Neck Intermediate £400.00 £220.00 Show arrow
S4183 Debridement and primary suture of wound with involvement of deeper tissue - Trunk and Limbs Intermediate £400.00 £220.00 Show arrow
S4212 Debridement and primary suture of wound without involvement of deeper tissue (skin and subcutaneous fat only) - Head and Neck Intermediate £400.00 £220.00 Show arrow
S4213 Debridement and primary suture of wound without involvement of deeper tissue (skin and subcutaneous fat only) - Trunk and Limbs Intermediate £400.00 £220.00 Show arrow
S4230 Secondary suture of skin Minor £100.00 £100.00 Show arrow
S4812 Insertion of skin expander into tissue Intermediate £400.00 £165.00 Show arrow
S4910 Adjustment to skin expander in subcutaneous tissue Minor £250.00 £110.00 Show arrow
S4950 Fat transfer, including extraction and volume adjustment, of scar defect following trauma (excluding breast) Intermediate £250.00 £110.00 Show arrow
S4930 Removal of skin expander or valve Intermediate £400.00 £165.00 Show arrow
S5710 Debridement of wound (and surgical toilet) - up to 25cm² in area Minor £150.00 £110.00 Show arrow
S5712 Debridement of wound (and surgical toilet) - over 25cm² in area Minor £150.00 £110.00 Show arrow
W0950 Radical clearance of sarcoma of trunk or limbs, +/- amputation or insertion of prosthesis Complex £750.00 £275.00 Show arrow
W0960 Excision of benign tumour of bone with bone grafting Xmajor £750.00 £275.00 Show arrow
W0951 Radical clearance of sarcoma of head and neck necessitating flap reconstruction Complex £1,000.00 £500.00 Show arrow

15.3 - Burns, scars and contractures

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



S5520 Burn excision (wound/scar) head, neck, hands, feet & genitalia, up to 9cm² Intermediate £400.00 £165.00 Show arrow
S5522 Burn excision (wound/scar) head, neck, hands, feet & genitalia, 9cm² - 25cm² Intermediate £400.00 £165.00 Show arrow
S5523 Burn excision (wound/scar) head, neck, hands, feet & genitalia, greater than 25cm² Major £500.00 £275.00 Show arrow
S5524 Burn excision (wound/scar) trunk & limbs (not more than 2% of body area) Intermediate £400.00 £165.00 Show arrow
S5525 Burn excision (wound/scar) trunk & limbs (between 2% and 10% of body area) Intermediate £400.00 £165.00 Show arrow
S5526 Burn excision (wound/scar) trunk & limbs (between 10% and 25% of body area) Major £500.00 £275.00 Show arrow
S5532 Dressing of burn of skin or subcutaneous tissue - less than 2% Minor £150.00 £200.00 Show arrow
S5533 Dressing of burn of skin or subcutaneous tissue - 2% - 10% Minor £150.00 £200.00 Show arrow
S5534 Dressing of burn of skin or subcutaneous tissue - 10% - 25% Minor £150.00 £200.00 Show arrow
S5535 Dressing of burn of skin or subcutaneous tissue - greater than 25% Minor £150.00 £200.00 Show arrow
S5560 Release of burn scar contracture, head, neck, hands, feet and genitalia Xmajor £600.00 £275.00 Show arrow
S5562 Release of burn scar contracture, trunk and limbs Major £500.00 £275.00 Show arrow

15.4 - Flaps and free skin grafts

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



Flaps

Unless explicitly stated these codes relate to the formation, division and transfer of the flap and include repair of the donor site. They do not include excision of skin or wound at the recipient site.

S2500 Local flap – less than 9cm2 Major £500.00 £165.00 Show arrow
S2502 Local flap – 9cm2 or more (excluding graft/flap to secondary defect) Major £500.00 £165.00 Show arrow
S2503 Local flap – 9cm2 or more (including graft/flap to secondary defect) Xmajor £500.00 £165.00 Show arrow
S1700 Distant flap – delay/division/inset Major £550.00 £275.00 Show arrow
S2002 Small island flap (less than 9cm2) Intermediate £650.00 £275.00 Show arrow
S2000 Large island skin flap (9cm2 or more) (eg radical forearm) including closure of secondary defect Xmajor £650.00 £275.00 Show arrow
S1740 Large myocutaneous (muscular/cutaneous) flap (9cm2 or more) including closure of secondary defect Xmajor £800.00 £440.00 Show arrow
B2984 Delayed reconstruction of breast using pedicled TRAM Complex £1,300.00 £495.00 Show arrow
S1750 Large muscle flap (9cm2 or more) including skin graft and closure of secondary defect Xmajor £550.00 £275.00 Show arrow
S2220 Neurovascular island flap Xmajor £650.00 £275.00 Show arrow
T7602 Microvascular free tissue transfer (when added to other codes) including closure of secondary defect Complex £1,000.00 £660.00 Show arrow
T7620 Free functioning muscle transfer (as sole procedure) including closure of secondary defect Complex £1,000.00 £660.00 Show arrow
S1900 Distant pedicle flap – elevation including transfer (including closure/grafting to secondary defect) Complex £550.00 £275.00 Show arrow
T7603 Microvascular free tissue transfer (as sole procedure including closure of secondary defect) Complex £1,000.00 £660.00 Show arrow
T7604 Vein/artery graft of part of microvascular free tissue transfer Major £750.00 £275.00 Show arrow
W3180 Free composite (ie including bone) vascularised grafts Complex £1,000.00 £660.00 Show arrow
S3100 Re-exploration of free flap Xmajor £1,000.00 £660.00 Show arrow


Free Skin Grafts

Unless explicitly stated these codes relate to the formation, division and transfer of the graft and include repair of the donor site. They do not include excision of skin or wound at the recipient site. All definitions relate to recipient sites unless otherwise stated.

S3500 Split autograft of skin, trunk and limbs – up to 25cm2 in area Intermediate £300.00 £165.00 Show arrow
S3530 Split autograft of skin, trunk and limbs – over 25cm2 and up to 5% of body surface area Major £550.00 £220.00 Show arrow
S3532 Split autograft of skin, trunk and limbs – each additional 5% of body surface area Major £550.00 £220.00 Show arrow
S3622 Full thickness graft, trunk and limbs – up to 9cm2 in area Intermediate £350.00 £220.00 Show arrow
S3623 Full thickness graft, trunk and limbs – each additional 25cm2 in area Minor £350.00 £220.00 Show arrow
S3624 Full thickness graft, head, neck, hands and genitalia – up to 9cm2 in area Major £350.00 £220.00 Show arrow
S3625 Full thickness graft, head, neck, hands and genitalia each additional 16cm2 in area Minor £350.00 £220.00 Show arrow



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