Otolaryngology Coding Alert

Question: Should I code an adjacent tissue transfer and the placement of fasciocutaneous flaps using the same code?

California Subscriber

Answer: You should not use an adjacent tissue transfer code to report a closure using a fasciocutaneous flap method. According to American Health Information Management Association (AHIMA), adjacent tissue transfer/rearrangement is defined as "the transfer of tissue to repair a defect such as traumatic avulsion, or an area where a large defect exists as the result of lesion excision. This procedure involves moving or lifting a normal, healthy section of skin (that remains connected at one or two of its borders) to an adjacent or nearby defect for the repair of the defect."

On the other hand, fasciocutaneous flap closures are tissue flaps consisting of skin, subcutaneous tissue, and underlying fascia. While adjacent tissue transfers are taken from an area adjacent to the surgical site, fasciocutaneous flaps are taken from any other portion of the body with a sufficient vascular supply.

As is referenced on pages 19-20, you will apply codes 140xx – 14xxx for adjacent tissue transfers. For example, if the surgeon performs an adjacent tissue transfer of under 10 cm on the ear, you will apply code 14060 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less). As per CPT^® and Correct Coding Initiative (CCI) guidelines, you should not report excision codes alongside adjacent tissue transfer codes.

As for placement of a fasciocutaenous flap of the head or neck, you should rely on the following CPT^® code:

• 15733 - Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae).