abaer01
Contributor
The provider performed DIEP flap procedure 19364 and coded 35206 for transposition of the cephalic vein into the breast pocket, as well as 35236 for transfer of the saphenous vein due to a gap between the cephalic and deep inferior epigastric. My question is about the appropriateness of 35206 for the cephalic vein transposition and supercharging of the flap. While researching the topic, I've found that 19364 includes microvascular transfer, and that the intra-service info for 19364 in EncoderPro states "the operating microscope is used to perform the microanastomosis of 1 artery and 1 vein." When looking at 19368 for TRAM flap, I see that the CPT code descriptor includes "requiring separate microvascular anastomosis (supercharging)." The supercharging is then described as an arterial microvascular anastomosis to boost blood flow when researching it further.
There is no NCCI bundling edit between 35206 and 19364, but I am confused about whether the transposition of the cephalic vein is included in the DIEP flap procedure 19364. The transfer of the saphenous vein seems to be separately reportable with 35236, as transfer of a vein from a distant site doesn't appear to be a component of 19364. Any help with this would be greatly appreciated. Procedure details attached.
There is no NCCI bundling edit between 35206 and 19364, but I am confused about whether the transposition of the cephalic vein is included in the DIEP flap procedure 19364. The transfer of the saphenous vein seems to be separately reportable with 35236, as transfer of a vein from a distant site doesn't appear to be a component of 19364. Any help with this would be greatly appreciated. Procedure details attached.
