General Surgery Coding Alert

Question: When our surgeon excises a melanoma of the face and closes using adjacent tissue transfer, can we report 14040 and 11643?

Georgia Subscriber

Answer: No, you should not report both 14040 (Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; defect 10 sq cm or less) and 11643 (Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm). You should report only 14040 for the closure using existing tissue transfer.

Here’s why: The lesion excision (11643) is included in the tissue transfer, according to CPT® rules.

Exception: If your surgeon performed the excision on a separate (earlier) day from the tissue transfer, you may report the procedures separately. This might happen, for example, if the physician wants to wait for the pathology report to be sure the margins are clear before closing the operative wound.

Caution: If the tissue transfer occurs on a later date but still during the excision’s 10-day global period, you must append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to the tissue transfer code (14040)