TnRushFan
Networker
Hello all,
Any input and discussion will be greatly appreciated.
One of our surgeons is suggesting we report 14031/14032 [adjacent tissue transfer] when releasing the fascia from subcutaneous tissue for less tension of closure during complex abdominal wall repair associated with hernia surgery. I am of the opinion that it should be reported with 15734 [component separation]. Have done some research on the subject and found a few references but would like to know what y'all think...below is one of the references.
https://bulletin.facs.org/2017/04/hernia-repair-complex-abdominal-wall-reconstruction/
Complex abdominal wall reconstruction
Large or complex abdominal wall hernias may require more than simple suture repair or repair with mesh. For these cases, a technique known as “component separation” (also known as the separation of parts operation) may be used to repair the hernia and reconstruct the abdominal wall defect. Component separation involves separating and creating musculofascial advancement flaps to facilitate closure of large midline hernia defects.
In one component separation technique, an anterior release mobilizes the entire rectus sheath toward the midline by incising the aponeurosis of the external oblique from the costal margin to the pubis. While protecting the neurovascular pedicles, the rectus flap is mobilized to bring the more medial tissues of the anterior abdominal wall toward the midline.
The posterior or transversus abdominis release musculofascial flap is another method to perform mobilization of the rectus sheath. Using this method, the same rectus muscle is advanced to the midline through release of the transversus abdominus in the posterior rectus plane while also preserving the neurovascular bundles
The work related to the hernia repair is reported with the appropriate hernia repair code and the work related to the component separation procedure is reported with code 15734, Muscle, myocutaneous, or fasciocutaneous flap, trunk. Medicare guidelines do not allow use of modifier 50 (bilateral procedure) with 15734. Therefore, if both sides of the rectus sheath are mobilized, you would report one unit of 15734 plus a second unit of 15734 with modifier 59 appended (15734, 15734-59) and bill full fee for both procedures. Payor software will apply modifier 51 as appropriate and reduce payment based on the multiple procedure reduction rule. For clarity, code 15734 represents a musculofascial flap involving the mobilization of the rectus muscle whether performed with anterior or posterior release. Code 15734 can only be reported once for each side. It cannot be reported four times—once for each posterior and anterior side. Only one muscle flap is mobilized on each side.
Additional coding considerations
The hernia repair codes and code 15734 include simple repair (12001–12007), intermediate repair (12031–12037), and/or complex repair (13100–13102) of skin and subcutaneous tissues. These codes should not be reported separately when the procedures are performed in conjunction with a hernia repair. Also, codes for adjacent tissue transfer (14000–14302) may not be reported with a hernia repair, even if extensive mobilization of skin and adipose tissue is performed.
The Current Procedural Terminology Professional Edition states: “Undermining alone of adjacent tissues to achieve closure, without additional incisions, does not constitute adjacent tissue transfer.”3
Any input and discussion will be greatly appreciated.
One of our surgeons is suggesting we report 14031/14032 [adjacent tissue transfer] when releasing the fascia from subcutaneous tissue for less tension of closure during complex abdominal wall repair associated with hernia surgery. I am of the opinion that it should be reported with 15734 [component separation]. Have done some research on the subject and found a few references but would like to know what y'all think...below is one of the references.
https://bulletin.facs.org/2017/04/hernia-repair-complex-abdominal-wall-reconstruction/
Complex abdominal wall reconstruction
Large or complex abdominal wall hernias may require more than simple suture repair or repair with mesh. For these cases, a technique known as “component separation” (also known as the separation of parts operation) may be used to repair the hernia and reconstruct the abdominal wall defect. Component separation involves separating and creating musculofascial advancement flaps to facilitate closure of large midline hernia defects.
In one component separation technique, an anterior release mobilizes the entire rectus sheath toward the midline by incising the aponeurosis of the external oblique from the costal margin to the pubis. While protecting the neurovascular pedicles, the rectus flap is mobilized to bring the more medial tissues of the anterior abdominal wall toward the midline.
The posterior or transversus abdominis release musculofascial flap is another method to perform mobilization of the rectus sheath. Using this method, the same rectus muscle is advanced to the midline through release of the transversus abdominus in the posterior rectus plane while also preserving the neurovascular bundles
The work related to the hernia repair is reported with the appropriate hernia repair code and the work related to the component separation procedure is reported with code 15734, Muscle, myocutaneous, or fasciocutaneous flap, trunk. Medicare guidelines do not allow use of modifier 50 (bilateral procedure) with 15734. Therefore, if both sides of the rectus sheath are mobilized, you would report one unit of 15734 plus a second unit of 15734 with modifier 59 appended (15734, 15734-59) and bill full fee for both procedures. Payor software will apply modifier 51 as appropriate and reduce payment based on the multiple procedure reduction rule. For clarity, code 15734 represents a musculofascial flap involving the mobilization of the rectus muscle whether performed with anterior or posterior release. Code 15734 can only be reported once for each side. It cannot be reported four times—once for each posterior and anterior side. Only one muscle flap is mobilized on each side.
Additional coding considerations
The hernia repair codes and code 15734 include simple repair (12001–12007), intermediate repair (12031–12037), and/or complex repair (13100–13102) of skin and subcutaneous tissues. These codes should not be reported separately when the procedures are performed in conjunction with a hernia repair. Also, codes for adjacent tissue transfer (14000–14302) may not be reported with a hernia repair, even if extensive mobilization of skin and adipose tissue is performed.
The Current Procedural Terminology Professional Edition states: “Undermining alone of adjacent tissues to achieve closure, without additional incisions, does not constitute adjacent tissue transfer.”3