General Surgery Coding Alert

Grab liposuction grafting upgrade.

When your surgeon performs a fat graft for conditions such as post-surgical or trauma repair, you need to be up to speed on several new code choices for next year to capture the work.

Let our experts demystify the nine code additions/deletions in the CPT^® 2020 Integumentary section so you’ll be ready to capture the pay you deserve beginning Jan. 1, 2020.

Master Fat Graft and More

You’ll find the following four new codes for fat liposuction and grafting in CPT^® 2020:

• 15771 (Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate)
• +15772 (…each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure))
• 15773 (Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate)
• +15774 (…each additional 25 cc injectate, or part thereof (List separately in addition to code for primary procedure)).

Remember: “Autologous is tissue originating from the same individual who will receive the tissue from the patient’s own body,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, associate partner, Pinnacle Enterprise Risk Consulting Services LLC.

Site: “Notice that these represent two code families based on the anatomic site to which the surgeon injects the autologous fat,” explains Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, national director of marketing and revenue management at FasPsych in Omaha, Nebr. Codes 15771 and +15772 describe injections to trunk, breasts, scalp, arms, and/or legs, while codes 15773 and +15774 describe injections to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet.

Quantity: The parent code in each family describes an initial quantity of injectate (less for the more delicate sites such as face), and the add-on code in each family describes each additional quantity (or part thereof) of injectate.

Other excision: If your surgeon directly excises fat (or other soft tissue) by a means other than liposuction for grafting, you can turn to new code 15769 (Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)).

Distinguish: Don’t confuse new code 15769 with existing code 15770 (Graft; derma-fat-fascia). “Use 15769 when the surgeon excises any of the three components, but reserve 15770 for when the surgeon excises all three tissues as one block for grafting,” explains Joy.

Old way: You may have been reporting fat grafting using 20926 (Tissue grafts, other (eg, paratenon, fat, dermis)). In fact, CPT® Assistant Oct. 2016 states, “Fat grafting is reported with code 20926. This code includes the work of harvesting the fat graft material by any method (eg, syringe, suction-assisted lipectomy, incision); closing the donor site, if indicated, and applying the appropriate dressing; processing the fat graft material; injecting the fat graft into the recipient site; and dressing the recipient site. Fat grafting involves a donor site, preparation of the graft, and a recipient site. Code 20926 is not anatomic site-specific, so it may be reported for any site when performed.”

New way: “CPT^® 2020 deletes 20926, so you should begin using the new codes in the Integumentary section to bill for these services beginning January 1,” Brame Joy says.

Don’t double dip: New codes 15771 to +15774 include injecting the fat-graft material into the recipient site, so you should not additionally report a code such as 11950-11954 (Subcutaneous injection of filling material (eg, collagen)…).

Don’t Miss The Move for Chest Wall Tumor Excision

CPT^® 2020 deletes some more codes from the Integumentary section:

• 19260 (Excision of chest wall tumor including ribs)
• 19271 (Excision of chest wall tumor involving ribs, with plastic reconstruction; without mediastinal lymphadenectomy)
• 19272 (…with mediastinal lymphadenectomy)

Don’t panic: If your surgeon performs these services, you’ll still have a clear way to report them beginning in January next year. That’s because you’ll find three new codes in the Musculoskeletal section with nearly-identical definitions, as follows:

• 21601 (Excision of chest wall tumor including rib(s))
• 21602 (Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy)
• 21603 (… with mediastinal lymphadenectomy).