Wiki Breast Reconstruction - reviewed Medicare

[vxhilaj]

Hello everyone, I work for a Plastic and Reconstructive Surgeon in Birmingham, MI. We just reviewed Medicare CCI edits and it is including 14301 (adjacent tissue transfers) in the breast reconstruction codes along with 15734. Our practice is primarily breast cancer patients, so these bundled codes are affecting the practice. Are there any other offices that are dealing with this issue? If so, does anyone have any insight or guidance? Thank you for your help!

 

[CodingKing]

According to the NCCI Manual:

Breast reconstruction procedures (CPT codes 19357-19369) include adjacent tissue transfer or rearrangement procedures (e.g., CPT codes 14000, 14001) if performed. An adjacent tissue transfer or rearrangement procedure may be reported on the same day as a breast reconstruction procedure if the adjacent tissue transfer or rearrangement is performed at a different site unrelated to the breast reconstruction procedure.

If you look at the CPT descriptions of the breast reconstruction codes, they specify the type of flap in the reconstruction code so you wouldn't report them separately. Usually things are added to NCCI when they are seeing an increase of incorrect coding of specific procedure. There doesn't appear to be any change to how these are coded and the Work RVU and rates have remained mostly unchanged (sight variances in practice expense and malpractice from CY 2014-2016). You may want to check to see if they were being coded correctly in the past. If you aren't including the cost of the flap when setting the rate for reconstruction procedures, You may need to look at increasing the rates for the primary procedure to account for the total cost.