Coders do not always understand that you can only code for the closure of the primary and secondary defect, but not for each flap that is created. March 15, 2018 Question: My doctor reports a breast revision with CPT codes 19380 and 20926 on the same breast. 14000 : Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less . If the tissue removed is primarily fatty tissue, the surgery is classified as cosmetic and will be denied as non-covered. Adjacent tissue transfer codes do not apply when the rearrangement of traumatic wounds incidentally results in an ATT/R configuration (e.g., Z-plasty, W-plasty), according to CPT … CPT Code Description Other Ancillary Services 15769 Grafting of autologous soft tissue, other, harvested by direct excision (e.g., fat, dermis, fascia) [See also the Medicare Advantage Policy … Breast reduction New instructional parentheticals were added to direct reporting code 19300, Mastectomy for gynecomastia, for breast tissue removed for breast reduction for … Based on CPT guidelines, excisions of benign lesions (11400–11446) and malignant lesions (11600–11646) cannot be reported separately with adjacent tissue transfer or rearrangement codes … Coding … Can you give suggestions on how the tissue transfers are worded? For implants used for reconstruction surgery, look to these two CPT® codes: 19340, Immediate insertion of breast prosthesis following mastopexy, mastectomy or in … [SEER … This type of flap is also referred to as a rhombic, bilobed, or nasolabial fold flap. We discussed that maybe we should bill using CPT 19366. Surgeon performed a breast lumpectomy with adjacent tissue transfer of 56 sq. And with an advancement flap, tissue is moved in a straight line and stretched over the defect. CPT 14302: Adjacent tissue transfer or rearrangement, any area; each additional 30 sq cm, or part thereof The CPT guidelines have some very specific rules regarding coding … ... 19296 Place po breast cath for rad All 19300 Removal of breast tissue All . A rotation flap is a curvilinear flap that closes a defect by a rotating the skin around a pivot point. The instructions that CPT® includes in the section notes state that the excision of benign lesion (11400-11446) or malignant lesion (11600-11646) is not separately reportable with 14000-14302. However, someone pointed out to me that according to CPT, 14301 … Since the lesion was malignant, the primary defect after margins was 1.6 sq.cm. • CPT codes 14000-14302 represent flaps for adjacent tissue transfer • The regions listed refer to recipient area (not the donor site) when a flap is being attached in a transfer or to a final site • Codes … cm and 15120 Split thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, first 100 sq. Barbara also provides litigation support as an expert witness for providers and payers.Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter. 14001 ; Adjacent tissue transfer or rearrangement… This is also referred to as a V-Y repair or flap. That doesn't specify 19301 but CPT Assistant does. 444 East Algonquin Road • Arlington Heights, IL 60005-4664 • 847-228-9900 • www.plasticsurgery.org 2 POSSIBLE CPT CODING Adjacent tissue transfer or rearrangement… Adjacent Tissue transfer / Rearrangement. A large defect is created in the nasolabial fold and the surgeon needs to create three flaps to close the defect.  Even though three flaps are created, three flaps cannot be coded because there is only one defect.  But the closure of the secondary defects that are created by all of the flaps may be coded for, so make sure they are accounted for in your coding and included in the claim. cm. A transposition flap is cut, lifted, and transferred over intervening tissue onto the defect. Note: If the wound repair or closure requires an Adjacent Tissue Transfer or Rearrangement (such as a Z-plasty or a rotation flap), the excision is not reported separately, but is included in the surgical package for the Adjacent Tissue Transfer or Rearrangement (See 14000-14350.). Surgeon performed a breast lumpectomy with adjacent tissue transfer of 56 sq. Answer: In addition to coding 19301 for the partial mastectomy, CPT code 19340 – (Immediate insertion of breast prostheses following mastopexy, mastectomy, or in … As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. Z –plasty, W-plasty, V-Y plasty, rotation flap, random island flap, advancement flap – Use CPT 14000 – 14302 (Excision and/ or repair by adjacent tissue transfer) Don’t code excision codes (11400-11446 & 11600-11646) along with adjacent tissue … If the adjacent tissue transfer closed both the primary defect and the secondary defect, add both the size of primary defect plus the size of the secondary defect to determine the size of the flap that is coded. ICD-9-CM implemented new codes in 2007 to report estrogen receptiveness of breast cancer. Op report reads: "The breast is mobilized in the subgranular and subcutaneous plane and then re-approximated in several layers using 2-0 Vicryl suture. This would be coded as: 14041 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck axillae, genitalia, hands and/or feet, defect 10.1 sq. registered for member area and forum access. MHO10 40O1014 CPT Codes … Rhinoplasty (CPT codes 30400-30450) When nasal surgery is … I often see incorrect medical coding for “flaps”, which were adjacent tissue transfers, 14000-14350. CPT Codes Requiring Prior Authorization As of Jan. 1, 2014 ... 14000 Skin tissue rearrangement 14001 Skin tissue rearrangement 14020 Skin tissue rearrangement ... 19296 Place po breast cath for rad 19300 Removal of breast tissue … 14000 ; Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less . Adjacent tissue transfers create secondary defects by their very nature, lifting-up skin and moving the skin over to cover the primary defect. CPT Code Description ... Insertion of tissue expander(s) for other than breast, including subsequent expansion . Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is an independent consultant, CRN Healthcare Solution, Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Preparation of moulage for custom breast implant: Other CPT codes related to the CPB: 19120 - 19126: Excision lesion of breast: 19300 - 19307: Mastectomy procedures: 21740 - 21743 : Reconstructive repair of pectus excavatum or carinatum : HCPCS codes … eyelids, nose, ears and/or lips, defect size 10 sq. Earn CEUs and the respect of your peers. In order to bill CPT 19366 a graft harvested from a location other than the breast is required. A .5 cm lesion is removed from the lip and face. As an example, if a reconstructed breast has fullness that requires liposuction, the coder would not assign code 15877. If this is your first visit, be sure to check out the. If you have the webinar package, they have one on demand titled Coding Breast Procedures. The Breast Cancer Gene Expression Ratio is based on the ratio of the expression of two genes: the homeobox gene-B13 (HOXB13) and the interleukin- 17B receptor gene (IL17BR). The primary defect is usually created from the excision of a benign or malignant lesion. This results in a 4.5 cm excised diameter defect. You must log in or register to reply here. Can we report the fat graft harvest in addition to the revision? The primary defect and the secondary defect are 1.6 cm plus 3.2 cm or 4.8 cm. Breast Cancer Index (BCI) is an RT-PCR assay performed on FFPE breast tumor tissue that integrates two gene expression-based biomarkers: 1) the HOXB13:IL17BR ratio (H/I), which is … Is there a CPT for this? I have always coded 19301 with 14301,58. The primary defect is 4.5 cm x 4.5 cm or 20.25 square cm. With that being said, he explained to me that they aren't performing a subcutaneous advancement flap, they are making additional incisions to create flaps of tissue that are advanced, rotated to fill the void in the lumpectomy cavity. The secondary defect required a split thickness graft harvested from the abdomen and was not closed by the adjacent tissue graft. CPT Codes Requiring Prior Authorization Procedure Code ... 14000 Skin tissue rearrangement All 14001 Skin tissue rearrangement All 14020 Skin tissue rearrangement All . cm. Report V86.0 for a positive status, seen in medical records as ER+, or V86.1 for no estrogen receptors (ER-). This is a good option for patients who are candidates for breast conservation therapy or lumpectomy, and are also candidates for breast reduction or mastopexy (breast lift). Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is an independent consultant, CRN Healthcare Solution, Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. cm or less. The adjacent tissue transfer will be coded as 14060, adjacent tissue transfer or rearrangement… 3. Also, the removal of the lesion to create the primary defect is considered included in the adjacent tissue arrangement. I code general, and some of my providers want to bill 14301 with their lumpectomy/mastectomy procedures, however in the CPT book it states ""undermining alone of adjacent tissues to achieve closure, without additional incisions, does not constitute adjacent tissue transfer, see complex repair codes." A 3.5 cm malignant lesion is removed from the face with .5 cm margins from the cheek. Closing the secondary defect is also coded in addition to the adjacent tissue transfer. We are trying different things & still getting denials. It may not display this or other websites correctly. The last slide discusses this topic and they suggest to bill 14301 in addition to 19301. Report both code 19020, Mastotomy with exploration or drainage of abscess, deep, and code 19101, … The text under the "Adjacent Tissue Transfer or Rearrangement" part of the CPT book, it reads about half way through: "The excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is not separately reportable with codes 14000-14302." The secondary closure may be part and parcel of the adjacent tissue transfer, which closes both the primary and secondary defect, or an additional graft may be needed to close the secondary defect, requiring an additional grafting code. 14000 Skin tissue rearrangement 14001 Skin tissue rearrangement 14020 Skin tissue rearrangement 14021 Skin tissue rearrangement ... 19318 Reduction of large breast 45790 OH Medicaid CPT Codes Requiring PA WEB.indd 5 10/9/14 2:44 PM. Let’s look at some examples. There may be microscopic residual tumor. I code for both general & plastics and we've never had an issue with 19301/14301 combination. I shared the "CPT Assistant October 2017 Surgery: Integumentary System article with my one of my breast surgeons and he said he agreed a subcutaneous advancement flap shouldn't be billed with 19301. Barbara also provides litigation support as an expert witness for providers and payers. The creation of the primary defect is included in an adjacent tissue transfer and not separately coded. code for primary procedure) 11960 : Insertion of tissue expander(s) for other than breast, including subsequent expansion . The code includes repositioning the breast… A biopsy of a mass or lesion is not inherent to a mastotomy for a breast abscess. In the practices I code for (Surgical Oncology) my surgeons call it "OncoPlastics closure Techinque" How I would code this, is the 19301-(RT, LT or 50) With the ICD for the path report results (C50.---, Z17.-, D05.--, N60.-- Whatever it may be) and then the 14301-51(it is not bundled and it was not done at a different time of the lumpectomy, with an open wound code. Answer: CPT code 19380, Revision of reconstructed breast involves revising an already reconstructed breast. Thus, CPT codes 11400-11646 and 12001-13160 should not be … You are using an out of date browser. 14001 : Adjacent tissue transfer or rearrangement… NCCI is consistent with these instructions, bundling these codes together.  However, other defect creations, such as Mohs micrographic surgery, and excision/radical resection of tumors of soft tissue (subcutaneous tissue, subfacisal, intramuscular) codes, eg: 21552-51558 are not considered incidental to these flaps and are not bundled. The tissue rearrangement is performed during the partial mastectomy procedure. If a split thickness graft or free graft is used to close the secondary defect, only the primary defect would be used to determine the size of the adjacent tissue flap that is coded. The adjacent tissue transfer will be coded as 14060, adjacent tissue transfer or rearrangement. We are looking for thought leaders to contribute content to AAPC’s Knowledge Center. The primary defect and the secondary defect are 1.6 cm plus 3.2 cm or 4.8 cm. 26994OH0812 CPT Codes … Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; … JavaScript is disabled. when used with Current Procedural Terminology (CPT) codes 19499, 32553, 49411, and 55876. The only code needed is 19380 for Revision of … Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less ... 19120 Exc cyst/aberrant breast tissue … Then the skin is closed in layers." The surgeon performs an adjacent tissue transfer from the cheek to close the defect, creating a secondary defect with flap dimensions of 3.2 cm x 1.0 cm which equals a secondary defect of 3.2 cm. In breast … Procedures coded 20–24 remove the gross primary tumor and some of the breast tissue (breast-conserving or -preserving surgery). and CPT coding guidelines for topics such as: tissue expander, pedicle flap, pressure ulcer, skin grafts, nail avulsion and excision, scar revision, burn treatment, lesion excisions, wound repair, adjacent tissue transfer/rearrangement, breast … Adjacent tissue transfer or rearrangement procedures include excision (CPT codes 11400-11646) and repair (12001-13160). Keep in mind that in all of these examples, the excision of the lesion was not separately coded and billed. 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