Oral Surgery Coding & Reimbursement Alert

Question: Our surgeon often gives us unlisted codes which makes it difficult to get paid. Following is an example:

He performed a “Revision of palatal island rotation flap.” It needed to be debrided and the formation of granulation tissue started. He suggested that we use 42299 paired with a diagnosis of C05.9. Can you suggest any other codes that are not “unlisted”?

Kansas Subscriber

Answer: If your surgeon is attempting to perform lengthening of the palate with an island flap, then you can report 42227 (Lengthening of palate, with island flap). Otherwise for “Revision of palatal island rotation flap,” 42299 (Unlisted procedure, palate, uvula) is the appropriate code.

His suggested diagnosis of C05.9 (Malignant neoplasm of palate, unspecified) also seems to be appropriate. If the neoplasm was confined to the soft palate only, you can try using C05.1 (Malignant neoplasm of soft palate). For overlapping sites (soft palate and hard palate) you can try using the ICD-10 code C05.8 (Malignant neoplasm of overlapping sites of palate).

Remember to include any documentation of the procedure and why reporting an “unlisted” code was the best option if you are still using 42299 as your code choice for the procedure performed.

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