General Surgery Coding Alert

Question: Our surgeon closed a deep abdominal wall defect that was approximately 440 sq. cm. using 300 sq. cm. flaps on each side. Should I report just the repair, or can I separately code the advancement flaps?

FloridaSubscriber

Answer: Given the limited description you present, the best code choice appears to be 15734 (Muscle, myocutaneous, or fasciocutaneous flap; trunk).

Because the description is not clear whether the advancement flap is part of the primary repair or a repair of the secondary defect, you don’t have adequate documentation to justify separately coding the advancement flap in this case.

Flap codes in the Integumentary section of CPT^® include approximation of the skin as part of the flap transfer. So 15734 includes setting the flap in place and approximating the muscle and skin edges.However, if the surgeon closed part of the defect with a myocutaneous flap and another part of the defect with advancement flaps, you could separately bill the donor site advancement flaps, if documented.

General rule: You can separately code for the advancement flap (14301-14302, Adjacent tissue transfer or rearrangement, any area; …) when used to repair the defect created at the donor site. CPT^® states in the guidelines for the section on Flaps (skin and/or Deep Tissues), “A repair of a donor site requiring a skin graft or local flaps is considered an additional separate procedure.”