General Surgery Coding Alert

Question: Our surgeon treated a patient with an amputated right ear. The surgical procedure involved microscopic replantation of the ear with microvascular anastomosis, and insetting and closure of cartilage, subcutaneous tissue and skin. How should we code the procedure?

Kansas Subscriber

Answer: You'll probably need to use an unlisted procedure code, such as 20999 (Unlisted procedure, musculoskeletal system, general). You can price the code based on reimbursement for similar procedures. Your surgeon will need to be part of deciding how complex the procedure was, and which CPT® codes represent a similar level of work for pricing purposes.

Although CPT® provides a family of replantation codes (20802-20838, Replantation ...) for appendages such as arm, thumb, and foot, there is not a code for ear. Nor does CPT® provide an "unlisted" replantation code that you can use.

That's why your best choice is 20999. Your surgeon might want to compare the procedure to one of the other replantation codes for pricing, or possibly to one of the free flap codes that include microvascular anastomosis (such as 15756, Free muscle or myocutaneous flap with microvascular anastomosis).