Anesthesia Coding Alert

Because the answer to the May question ("Which anesthesia code corresponds with grafting procedure 15736 [muscle, myocutaneous, or fasciocutaneous flap; upper extremity]?") prompted several inquiries and much interest, Anesthesia Coding Alert consulting editor Barbara Johnson, CPC, MPC, professional coder with Loma Linda University Anesthesiology Medical Group Inc. of Loma Linda, Calif., chose to discuss the issue further.   

Codes 15732-15738 are the only four in the CPT grafts and flaps section that use the donor rather than the recipient site.  However, it's easy to miss the statement in CPT that clarifies the donor versus recipient site (which is in parentheses just above these codes) and misinterpret the coding. It reads: "Procedures 15732-15738 are described by donor site of the muscle, myocutaneous, or fasciocutaneous flap." 

If you follow the guideline for this type of graft and use 15736, the ASA Crosswalk recommends 01610, 01710 and 01810. The presumption in formulating the answer was that the graft was taken from the upper extremity and transferred to the area of the body in need of repair.

If the question above were modified by adding more specific information, the question and answer would read as follows: 

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?

Answer: Following the guidelines for this type of graft, use CPT 15734, which crosswalks to anesthesia codes 00400, 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 uses CPT codes 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.