# CPT 20969 - Radial Forearm Free Flap



## Robin R (Jun 8, 2010)

patient has a mandibular defect & surgeon is doing a radial forearm free flap - CPT 20969.

He then does a skin graft on the donor site for closure.  In the CPT for skin/deep tissue flaps (15XXX), it states "A repair of a donor site required a skin graft or local flaps is considered an additional separate procedure."  Is this true for bone grafts as well?  

The donor site repair isn't mentioned anywhere in the bone graft section (209XX), but would the same rules apply?

I say the skin graft should be coded & my doc is saying that it's unbundling.  I'm finding lots of documentation for the skin/deep tissue grafts & nothing for bone grafts!

Any suggestions???

Thank you for your help!


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## hillards@gmail.com (Jun 9, 2010)

Hi,
I am new to plastic surgery coding and and the only coder for my company.  I cannot answer your question due to my inexperience.  I was wondering if you would be able to send me any notes or general guidelines you may know about plastic surgery coding. 

I am scratching and clawing to find out what I can.  I have only done about 10 charts so far.  Mainly wound excision, flaps, and breast reconstruction.

Are there any books you recommend?  I am only working with the CPT and ICD-9 books right now.

If you can help me at all, I would appreciate it.

My email is hillards@gmail.com and my name in Connie Hillard.

Thanks,
Connie


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## Robin R (Jun 9, 2010)

Hi Connie!

I know exactly where you are coming from.  I'm not a Plastics coder either, but got thrown into it with VERY little training.  Google has been a GREAT help to me.  They have an area called Google Books where you can actually read some of the books.  There are no CPTs involved in these ones but they give GREAT descriptions of all the different types of procedures:

Grabb's Encyclopedia of Flaps: Volume I: Head and Neck (there's a search box on the left hand side where you can search for the procedure you are looking for)

http://books.google.com/books?id=OF...ume+I:+Head+and+Neck&cd=1#v=onepage&q&f=false

The Plastic Surgery And Dermatology Coding Guide for Ambulatory Surgery Centers (this one actually lists CPTs):

http://books.google.com/books?id=UX...tory+Surgery+Centers&cd=1#v=onepage&q&f=false

General Orthopaedics (Even though it's an Ortho based book, this one has a good description of various skin, muscle, etc flaps):

http://books.google.com/books?id=Pv...General+Orthopaedics&cd=1#v=onepage&q&f=false

A lot of times I find things just by Googling something like "sural artery flap cpt" or whatever procedure you are looking for.

Send me a PM if there's any specific questions.  I don't know everything, but I can try to help!

Oh, I've also heard that the Coding Companion books for Plastics & Ortho are helpful, but I haven't personally used them.

Good luck!

Robin


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