Wiki Breast lumpectomy w/ adjacent tissue transfer

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kimberliterpstra

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Surgeon performed a breast lumpectomy with adjacent tissue transfer of 56 sq. cm.
I have always coded 19301 with 14301,58.
However, someone pointed out to me that according to CPT, 14301 is "used for excision (including lesion) and/or repair by adjacent tissue transfer or rearrangement."
My sticking point is the "and/or"... if I apply the "and" portion to my coding scenario, that means I can only code 14301. If I apply the "or" portion to my coding scenario, that means I can code both 19301 and 14301...or does it?
 
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The text under the "Adjacent Tissue Transfer or Rearrangement" part of the CPT book, it reads about half way through: "The excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is not separately reportable with codes 14000-14302." That doesn't specify 19301 but CPT Assistant does.
"CPT Assistant October 2017 Surgery: Integumentary System
Question: Is it appropriate to report Current Procedural Terminology (CPT®) code 14000 or 14001 for a subcutaneous advancement flap for closure after a lumpectomy (or partial mastectomy)?
Answer:No, it is not appropriate to report either code 14000, Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less, or 14001, Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm, in addition to code 19301, Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy), because simple, intermediate, and complex layered closure is included in the work represented by code 19301."
 
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I shared the "CPT Assistant October 2017 Surgery: Integumentary System article with my one of my breast surgeons and he said he agreed a subcutaneous advancement flap shouldn't be billed with 19301. With that being said, he explained to me that they aren't performing a subcutaneous advancement flap, they are making additional incisions to create flaps of tissue that are advanced, rotated to fill the void in the lumpectomy cavity. We discussed that maybe we should bill using CPT 19366.
 
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If you have the webinar package, they have one on demand titled Coding Breast Procedures. The last slide discusses this topic and they suggest to bill 14301 in addition to 19301. In order to bill CPT 19366 a graft harvested from a location other than the breast is required. I code for both general & plastics and we've never had an issue with 19301/14301 combination.
 
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sisadavis said:
If you have the webinar package, they have one on demand titled Coding Breast Procedures. The last slide discusses this topic and they suggest to bill 14301 in addition to 19301. In order to bill CPT 19366 a graft harvested from a location other than the breast is required. I code for both general & plastics and we've never had an issue with 19301/14301 combination.
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I code these 2 codes together & I get a lot of denials. Even after they are appealed they say the documentation doesn't support the 14001, even though it is clearly documented. Sometimes they say it is included in the 19301. Any suggestions on how you are getting it paid? Thanks.
 
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In the practices I code for (Surgical Oncology) my surgeons call it "OncoPlastics closure Techinque" How I would code this, is the 19301-(RT, LT or 50) With the ICD for the path report results (C50.---, Z17.-, D05.--, N60.-- Whatever it may be) and then the 14301-51(it is not bundled and it was not done at a different time of the lumpectomy, with an open wound code. Depending on which breast it was completed on (S21.001A for RT, S21.002A for LT) I have never gotten a denial.
 
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I code general, and some of my providers want to bill 14301 with their lumpectomy/mastectomy procedures, however in the CPT book it states ""undermining alone of adjacent tissues to achieve closure, without additional incisions, does not constitute adjacent tissue transfer, see complex repair codes." So if that's what they're documenting, then it's bundled into the excision. The key appears to be to document additional incisions and secondary defects related to the tissue transfer.
 
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Kellyg45 said:
I code these 2 codes together & I get a lot of denials. Even after they are appealed they say the documentation doesn't support the 14001, even though it is clearly documented. Sometimes they say it is included in the 19301. Any suggestions on how you are getting it paid? Thanks.
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Hi which webinar are you referring and can you provide more info please.

thank you
garcia06
 
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Have you used modifier 59 with 14001, also I have learned that the measurements has to be included in documentation when using 14001.
 
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