Wiki Adjacent tissue transfer - I have a surgeon who continues to code for adjacent tissue

[phillirk]

I have a surgeon who continues to code for adjacent tissue transfer/rearrangement codes for benign nevus excisions. He states other plastic surgeons are reporting these codes (14000-14350). I'm beginning to doubt myself that I am missing something. Here is one he wants coded 14060 with 11900 for the Kenalog injection. I'm starting to wonder if I am the one who isn't correct in my thinking.

Please help. Thank you.


DESCRIPTION OF PROCEDURE: After informed consent was obtained, he was taken to the operating room, placed supine on the operating table. After adequate general endotracheal anesthesia was induced, his head and neck was prepped and draped in standard surgical fashion. Indelible ink marking pen was used to mark out a thin rim of normal skin around the raised nevus on the right medial canthus. An 11 blade scalpel was then used to sharply incise the skin. The lesion is dissected from the surrounding tissue and passed off the field as specimen. Good hemostasis was assured with electrocautery. The wound edges were reapproximated with interrupted 5-0 Vicryl sutures and then 6-0 plain gut sutures for skin layer. Antibiotic ointment was applied. Attention was then directed to the right forearm. A total of 0.3 mL of Kenalog 40 was injected into the hypertrophic scar. A sterile dressing is applied. Sponge, needle and instrument counts were correct at the end of the procedure. The patient tolerated the procedure well, was transported to the recovery room in good condition.

 

[ABonnell CPC]

I'm always cautious when one of the surgeons here, says, hey...lets bill it this way, because I've talked to another surgeon that is doing this. So, I do my research, and advise appropriately. Experimenting with coding on claims is costly.

I think the best thing to reference here would be the CPT guidelines for Excision-Benign Lesions. There may be some confusion amongst the surgeons talking. Included in the adjacent tissue transfers is the excision of the lesion, therefore, you're not coding that separately. Refer to the adjacent tissue transfer descriptions in CPT.

Some surgeons may be billing AND getting paid right now, but in the event that an audit should happen, they may end up having to issue refunds.

 

[Nichole9288]

Sorry, but his note does not state a local flap, Z-plasy, V-Y plasty,etc was done. Based on this note I would code a benign excision with an intermediate wound repair (due to multiple layers of sutures...if he gives you the length of the repair).

I code these all the time and a local tissue rearrangement is not what he documented in my opinion.

Do you have access to a Coder's Desk reference for your surgeon? I would print a copy of that page & have him read it over as it details what CPT 14060 is...the adjacent tissue needs to be rearranged over the defect, not merely closing the skin layers.

Best of luck to you!