General Surgery Coding Alert

Question: The surgeon excised a basal cell carcinoma from the patient's right ear. To close the wound, the surgeon inserted a tubed pedicle flap that didn't match the size of the defect. He then performed a Z-plasty to cover the remaining defect. Can I bill for both the pedicle flap and the Z-plasty? Utah Subscriber Answer: Yes. As long as the documentation supports it, you can bill 14060 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears, and/or lips; defect 10 sq cm or less) and 15576 (Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral) on the same claim. You can use flap and graft codes together when the surgical note supports that the physician performed both procedures. Differentiate transfer from repair: For adjacent tissue transfer or rearrangement, the surgeon typically reports that the specific defect, excision, or laceration needs surrounding tissue rearrangement [...]