Otolaryngology Coding Alert

Tissue transfers also fare prominently among CCI 16.0's non-mutually exclusive edits. Other common bundles include -- along with debridement -- intermediate repair, complex/simple repair, excision, skin graft, and moderate sedation.

Fact: Non-mutually exclusive edits pair codes for two services that physicians often perform during the same session. CCI lists one code as the comprehensive procedure -- meaning it's considered the larger procedure -- and the second code as the component, which is a piece of the comprehensive.

You should now bundle 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm) with:

• Debridement codes 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface) and 11040-11042 (Debridement; skin ...).

• Complex repair codes 13131-13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet), 13120 (Repair, complex, scalp, arms and/or legs; 1.1 to 2.5 cm for the complex repair of the 2.0-cm benign lesion on the left arm), 13100-13101 (Complex wound repair), and 13150- 13152 (Complex facial wound repair).

• Tissue rearrangements code 14021 (Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm).

• Wound care code 97602 (Removal of devitalized tissue from wound[s], nonselective debridement, without anesthesia [e.g., wet-to-moist dressings, enzymatic, abrasion], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session).

• Moderate sedation codes (99148-99150).

• Intermediate repair (layer closure of wounds) codes 12051-12057, 12041-12046, and 12031-12037. These all describe layer closure of wounds.

• Simple repair codes 12011-12021 (Simple repair of superficial wound; face, ears, eyelids, nose, lips and/or mucous membranes) and 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]...).

• Excision of malignant lesion codes 11600-11646.(These bundles are consistent with the instructions in front of the "adjacent tissue transfer" codes, notes Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of CRN Healthcare Solutions in New Jersey. CPT's guidelines indicate that the lesion removal is included in the flap and cannot be coded separately, Same goes for:

• Excision of benign lesion codes 11400-11471.