subject: Surgery Coding Challenge : Keep Flaps Straight To Select The Right Cod [print this page] Find out why coding myofascial flap twice is a big mistake.
Question: Our surgeon carries out an abdominal closure using left and right myofascial advancement flaps. I believe that we should code one unit of 15734 as flab codes refer to the recipient area "" and not donor site. However the surgeon thinks that we should code 15734 x 2 because he uses two flaps to perform the defect closure. What is the correct coding here?
Answer: You should not go for 15734 for this service "" either once or twice. In its place, you should list the procedure using an adjacent tissue transfer code like 14000 (Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less) or 14001 (defect 10.1 sq cm to 30.0 sq cm) depending on the defect size.
The Reason: Adjacent tissue transfer rearrangement covers repair by advancement flaps, as per CPT instruction in the introduction to those codes. While on the other hand, 15734 doesn"t specifically include myofascial flaps and doesn"t describe advancement flaps for closure.
Size does matter: Rather than coding this twice, you should code the entire size of the primary and secondary defects (inclusive of secondary defects for both flaps). If the defect happens to be larger than 30.0 cm, you can still use the adjacent tissue transfer or rearrangement codes by listing 14301 (Adjacent tissue transfer or rearrangement codes by listing 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm) and adding +14302 ("every additional 30.0 sq cm, or part thereof {list differently in addition to code for primary procedure} as required.
