When Wound Repair Isn't Enough, Turn to Tissue Transfers:
6 Steps Show You How
Published on Mon Apr 23, 2007
You won't report lesion excision separately
When the surgeon performs adjacent tissue transfer (for instance, to close a large or irregular wound following lesion removal), you must be sure to add together the area of both the primary and secondary defect to choose the correct code. But that's only the beginning: Successful tissue transfer coding requires that you follow at least six steps. 1. Differentiate Transfers From Repairs
When reading physician documentation, you must know what separates tissue transfer (14000-14300) from closures as described by repair codes 12001-13160.
In a nutshell: During simple, intermediate or complex repair (12001-13160), the surgeon cleans and sutures the wound. Adjacent tissue transfer involves freeing tissue from around the wound and literally rearranging it to cover the defect.
Recognize the difference: -For adjacent tissue transfer or rearrangement, you should see the surgeon document that the specific defect, excision or laceration needs surrounding tissue rearrangement to accomplish final closure. These include Z-plasty, W or V-Y plasty, rotation flaps, local advancement flaps, and double pedicle flaps,- says John Bishop, PA-C, CPC, president of Bishop and Associates in Tampa, Fla. -The original tissue maintains its blood supply and is carefully -moved- into position for final wound closure.-
-The easiest method [to differentiate tissue rearrangement from repair] is to identify whether any of the processes described in the CPT Adjacent Tissue Transfer or Rearrangement section guidelines are described (such as Z-plasty and so on),- says Terri Brame, CPC, CPC-H, operations manager for the Division of Clinical Revenue at the University of Washington department of surgery. -Another tip is that a -primary- and -secondary- defect are addressed.-
Finally, unlike repair as described by 12001-13160, the flap creation during tissue transfer results in a -secondary defect- in addition to the -primary defect- of the wound itself.
-The primary defect is the one being repaired, and the secondary defect is the defect created by lifting the adjacent tissue,- Brame says.
Important: Surgeons may perform an additional closure or skin graft to repair the secondary defect (see below).
Usually, surgeons use tissue transfer to minimize scarring when repairing wounds that are too large or deep for a complex repair.
2. Determine Overall Area and Location
To select the appropriate tissue transfer code, you must determine the total area (in sq cm) of the primary and secondary defects, according to CPT instructions. In addition, you must consider the repair's anatomical location. (Use the chart on page 31 to find the correct tissue transfer code at a glance.)
Example: Your surgeon removes a lesion measuring 2 cm x 2 cm from a patient's right forearm. To repair this primary defect, the surgeon creates a flap measuring 4 cm x 2.5 cm. To determine the total area, add together the area of the primary defect (2 [...]
