Otolaryngology Coding Alert

Question: A patient underwent plastic surgery to reconstruct the nose and septum after they had a procedure to resect a facial neoplasm. We submitted the claim for the reconstruction, listing the appropriate cancer ICD-10 code first, but it was denied. Where did we go wrong?

Virginia Subscriber

Answer: The misstep was using the ICD-10 code for the cancer as the principal diagnosis. When patients undergo resection of a facial neoplasm, the doctor may perform plastic surgery reconstruction of the nose and septum after tumor resection. The reconstruction may involve flaps and grafts, rhinoplasty, septoplasty, or septal construction after removal due to neoplastic tissue.

When your otolaryngologist performs these types of subsequent reconstructive procedures, you need to use Z42.8 (Encounter for other plastic and reconstructive surgery following medical procedure or healed injury), and it must be the first-listed code. Because ICD-10 indicates this is a principal diagnosis, you will always list it first when the reconstruction is performed as a follow-up to a prior medical procedure. You should list all other ICD-10 codes after Z42.8. This tells the payer that this is a medically necessary procedure.