# Raising Flaps



## SUEV (Feb 4, 2009)

My physician excised a lesion and then did a 10cm layered repair with flaps.  I spoke with him to find out what that entails and he said that he has to undermine extensively to raise the flaps, which would mean it's a complex closure.  Since the undermining is inherent in raising the flaps, would the undermining have to be mentioned to support the complex closure repair?  The exact words he used regarding the flap only are:

"...The lesion was excised, appropriately oriented with sutures, and submitted for pathologic examination.  Flaps were then raised for at least 50% of the circumference of the forearm to allow closure.  Hemostasis was obtained with ligation and cautery.  A 2-layer closure was then performed with a running 3-0 Vicryl suture to reapproximate the deeper space and surgical clips to approximate the skin..."

Would this be enough documentation to support a complex closure code?  If so, since the whole length didn't involve the flap, do I have to bill an intermediate along with the complex code?

Thanks for any advice you can give me!
Sue


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## FTessaBartels (Feb 4, 2009)

*Please see CPT guidelines*

Sue,
Please look at the guidelines for flaps (2009 CPT Professional edition, page 60).  I quote in part: "The excision of a benign lesion (11400-11446) or a mlaignant lesion(11600-11646) is *not* spearately reportable with codes 14000-14300."  (emphasis added by FTB)

Play close attention to how to determine the size of the defect, as you add the primary and secondary defect together to determine the size. 

The surgeon will likely have to dictate an addendum to give you this information. Based on the limited info you've posted I'm thinking that 14020 will probably be the code you use. 

F Tessa Bartels, CPC, CEMC


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## SUEV (Feb 4, 2009)

I was planning on using the 13000 codes (complex repair), since there wasn't mention of rearranging tissue like z-plastys, etc.  Should the 14000 codes be used for all flaps?  Is that the difference between the 13000 & 14000 codes?
Thanks for replying and your help,
Sue


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## FTessaBartels (Feb 5, 2009)

*Need better documentation*

You'll have to query your doctor on this, because the documentation is somewhat vague. Were the flaps raised in order to get at a lesion that was BENEATH the skin?  Or was the lesion excised, and then an adjacent flap(s) raised to repair the resulting defect?


F Tessa Bartels, CPC, CEMC


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## KLRuhe (Feb 9, 2009)

If the physician is raising flaps for 50% of the circumference of the arm in order to close, that sounds like an advancement flap and I agree with 14020.

Kay, CPC, CCS-P


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