Orthopedic Coding Alert

Use this advice to help you distinguish between skin and myocutaneous flaps.

1. Look for how deep your surgeon goes to prepare the graft. "The depth of the tissue that is transferred for the flap is the deciding factor for code selection," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington. "A skin flap graft utilizes full thickness tissue containing epidermis, dermis and subcutaneous tissue. This tissue is transferred with its blood supply intact. A myocutaneous flap is a vascularized combination flap of skin and muscle that is transferred to the recipient site. These flaps commonly remain attached to the donor site by a pedicle that is "taken down" at a later surgical encounter."

2. The anatomic location of the sore is also a deciding factor for the choice of grafts. "Pressure sores of the sacrum are not commonly closed with primary closure due to the high complication rates and failure primary of closure," says Stumpf. "Vascularized tissue has a much higher rate of success in closure of these complex wounds. The padding often needs to be replaced over the sacrum to avoid future reoccurrence of the pressure ulcer. A vascularized myocutaneous flap graft is often utilized to recreate the 'pad' over the sacrum and is the preferred closure for deeper sacral ulcers."