Anesthesia Coding Alert

Question: Which anesthesia code corresponds with a grafting procedure using a muscle flap from the latissimus dorsi muscle and placing that graft over a wound of the upper extremity?

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Answer: Following the guidelines for this type of graft, use CPT^® code 15734 (Muscle, myocutaneous, or fasciocutaneous flap; trunk), which crosswalks to anesthesia codes 00300, 00700, 00730, 00800 and 00820. Because the latissimus dorsi is in the upper back (thoracodorsal region), use 00300 (Anesthesia for procedures on the integumentary system, muscles and nerves of head, neck and posterior trunk, not otherwise specified) or 00700 (Anesthesia for procedures on upper anterior abdominal wall; not otherwise specified).

It’s strongly recommended that each coder who reports 15732-15738 highlight the notation regarding the coding from donor site. Interestingly enough, in reviewing CPT^®, the AMA has never addressed the question about using only donor sites for these four codes. This is the type of topic coders can continually debate, but they have an obligation to decide whether a code is appropriate. The final outcome can only come during an audit or in reviewing codes with your physician.

The key to coding correctly and avoiding an audit is physician documentation -- they must provide adequate information in their dictation or hand-written notes. And you must be aware that the codes you choose are always open to scrutiny and inquiry so you must be able to back your choices. Also realize that, in many cases, there is no wrong or right, just disagreement with a crosswalk code, another coder, your physician or another source.