# takedown of Flap revision after Mohs



## Texascoder64 (Jun 26, 2014)

If a patient had Mohs with an adjacent tissue transfer (flap) on the forehead, and 2 weeks later came back and the note states, "take down the forehead flap and do revision" 
The op note is not very clear of what exactly was done - the physician said a "full flap was done again.  There was perineural invasion on permanent blocks and looks like an excision was done and another flap, which I know only a flap can be charged. Is there anything else to consider for the codes when they do a takedown of a recent flap and redo?

thank you


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## CatchTheWind (Jun 26, 2014)

Because flaps have a 90 day global, my understanding is that anything that has to be redone during the 90 days is not billable.  (Per CMS, ?The global surgery payment includes? all additional medical or surgical services? during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room?.  An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term... does not include... a minor treatment room...."  http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf

I know this does not seem fair, and I have wondered if in cases like this the flap code could be revised and resubmitted with a 22 modifier ("increased service").  I've never tried it, but would be interested in hearing others' experiences or opinions!


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## Texascoder64 (Jul 1, 2014)

I question if the correct flap code was used for the first procedure when the physician explained what was done. The description given was:
(this is a nose cancer/nasal defect,  a forehead flap was done initially, then  
The flap stayed reattached for because of blood supply.  You have to develop a blood supply before doing the 2nd revision and cutting the extra skin to take the flap down. 
***sorry the OP note is note is not very specific other than the description above.
what CPT's would you use?

would it be 14301/02 (based on size given on op) 
OR
since this was a flap that stayed attached for blood supply to nose and cut the extra skin 2 weeks later would this be coded:
15574 then 2 weeks later 15630-58?

Thank you


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