# help with 20926



## BFAITHFUL (Nov 23, 2009)

the doctor wants to bill cpt 20926 & describes as the following,

the hematoma and deformity of the right cheek was addressed first obtaining 10cc of fat through a stab wound.  The  fat was carefully decanted and the dermal fat cells were obtained.  These were immediately injected through multiple stab wounds into the deformity using an 18-gauge needle.    

Is this correct?  I've never billed for this code before & don't know if this documentation is enough to support coding this.


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## coderguy1939 (Nov 25, 2009)

20926 is the harvesting of the fat graft. The harvesting should be from a separate site and documented as such in the op note.

Except for the incisions in the skin, the injections of the fat sound like the 11950-11954 codes which lay descriptions include injections of autologous fat as a dermal filler.

Don't know if that will get you there.


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## tinaboe (Nov 30, 2009)

According to the American Society of Plastic Surgeons it is appropriate to use the fat grafting code 20926 for which your doctor describes.  

This code includes; 

Harvesting of the fat graft material by any method (e.g. syringe, suction assisted lipectomy, incision)

Closure of the donor site, if indicated, and appropriate bandage

Processing of fat graft material

Injection of fat graft into receipeint site

Bandaging of recipient site

They also state that the use of the four codes (11950 - 11954) describe "subcutaneous injection of filling material (e.g. collagen).  "These codes should not be used to report fat injecions, as they belie the extent of these procedures..  These codes are used for "off the shelf" products such as collagen, where a product ready for use is injected into the soft tissues.  These do not involve the harvest of  tissue, and hence no donor site involvement or postoperative care.  They do not describe the more involved procedure of fat grafting.


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## coderguy1939 (Nov 30, 2009)

I'd certainly take the ASPS into consideration when coding, but here is what the lay description of 20926 states in CPT:

The physician obtains a paratenon, fat, or dermis graft. The physician incises the skin and retracts the skin flap to expose the underlying connective tissue. The tissue is incised to the required layer. The graft is lifted and implanted in the recipient site in a separately reportable procedure. The donor site is sutured in layers. 

Seems pretty clear that the implantation of the material should be reported separately.  Whether or not 11950 - 11954 are the appropriate codes is debatable, but the lay description includes autologous fat which is not "off the shelf product" as stated by ASPS.

Depends on who you want to follow.


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## BFAITHFUL (Dec 2, 2009)

thanks to both of you.


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