Otolaryngology Coding Alert

Question: My doctor did a major ear surgery on a man who has radiation necrosis of the temporal bone, atresia due to radiation of inner ear, necrosis of canal wall due to radiation. He then did what he listed as rotation of temporalis muscle flap, rotation of sternocleidomastoid flap, and rotation of postauricular skin flap. How should I code these procedures?


Illinois Subscriber

Answer: The otolaryngologist described rotated muscle flaps, which you should report using 15732 (Muscle, myocutaneous, or fasciocutaneous flap; head and neck [e.g., temporalis, masseter muscle, sternocleidomastoid, levator scapulae]). Documentation for 15732 should clearly describe a rotated muscle flap in meticulous detail. The op report should detail how the surgeon created the muscle flap and performed the closure.

If the otolaryngologist did indeed create three flaps, use modifier 59 (Distinct procedural service) on the second two flap codes. The modifier designates the additional flaps as occurring on separate sites. You would report to an insurer that accepts units: 15732-59 x 3.

For payers that do not process units, line itemize each flap as: 

- 15732-59
- 15732-59
- 15732-59.

Money-maker: Repair of the donor site is separately billable. Although you do not indicate this procedure in your description, make sure you capture this added value if your otolaryngologist performed this work.

When coding muscle, myocutaneous or fasciocutaneous flaps, pay attention to the donor site of the flap, not the defect site. So the flaps come from the head and neck. The defect site (the inner ear) is not important. In contrast, code free grafts (15050-15321, 15340-15366, 15420-15431, 15757) and adjacent tissue transfers (14000-14350) based on the defect site.

Answers reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.