# Rotation Flap Billing Question



## JFoushee12 (Jul 1, 2014)

Can you bill 2 separate rotation flaps on the same defect or do you just add them together? For clarification, that is 2 separate secondary defects for the same primary defect???? See provider notes below. 

Lesion Location: left anterior ala 
Reason for Removal: pathology confirmed malignancy 
Repair: rotation flap x 2 elected to preserve normal anatomy - superior flap corrected defect on the left nasal tip and the inferior flap was used to correct the defect on the L ala
Size of Flap: superior flap - 2.5cm squared including primary and secondary defect. Inferior flap 3.0cm squared including primary and secondary defects
Deep Layer Sutures: 5-0 monocryl buried 
Skin Layer Sutures: 5-0 monocryl running, 5-0 monocryl interrupted 
EBL: Minimal 

I know if there is a graft or a rotation flap required on the secondary defect you can bill it. . . but both of these flaps are on the primary defect. 

Look forward to seeing what you think. I cannot find anything specifically addressing 2 rotation flaps on the same primary lesion/defect. Thanks! Janelle


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## ABonnell CPC (Jul 1, 2014)

I do not have any articles to reference, but I would bill for 2 separate flaps.  Because of the nasal anatomy, etc...1 flap could not be used to reconstruct both part of the nose, even though it was create by just one lesion.


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## CatchTheWind (Jul 2, 2014)

I also have no reference, but my expectation would be that you would have to add up the square cm. of all three sites and bill as a single flap. 

My logic comes from the rule for billing bilobed flaps (when a third - also contiguous - site is used as a flap to repair the second site).  In that case, you have to bill as a single flap (adding up all the sizes together).  I can't recall my source for that, but I know that I had researched it and that this is a definitive rule.


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## Texascoder64 (Jul 2, 2014)

I agree with adding together all 3 areas - this will more than likely be a larger flap using the  cpt code 14301  30.1 - 60 sq cm ,  and for  each add'l 30 sq cm use cpt 14302(with appropriate units)


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