Wiki Lateral Serratus Muscle Flap & Alloderm

[Joyce Burchett]

Pt. had bilateral mastectomies by general surgeon & plastics is doing bilateral immediate tissue expander reconstruction with lateral serratus muscle flap & use of alloderm. Lateral edge of pectoralis muscle was then elevated & subpectoral pocket created. The inferior edge of the pectoralis muscle was released to the sternal border. Both of the flaps were elevated partially splitting the pectoralis minor & pectroalis anterior. An 8 x 16 sheet of alloderm was hydrated. This was then set at the inframammary fold starting medial to lateral. Implant was chosen & placed in the pocket & tab sutured to hold in place. Inferior edge of the pectoralis muscle was then sutured to the edge of the alloderm from medical to lateral. The serratus muscle flap was then advanced to cover the lateral edge of the pectoralis muscles as well as lateral edge of the alloderm. Tissue expanders placed to 100 ml. Some excess redundant breast skin excised. Wounds irrigated, hemostasis acheived & 10-15 roun blake drains placed & closed with 3-0 monocryl suture. Same procedure performed bilaterally.
CPT codes used 19357-50, 19366-50 & 59, 15273. I'm not sure this is correct. I can't find any CPT for lateral serratus muscle flap. I agree with 19357 but not sure 19366 or 15273 is correct. I was wondering if we should use 15734 & 15777. Can anyone please advise?

 

[ABonnell CPC]

It sounds like there is A LOT of confusion, and there isnt enough of the op report. But based on what I see, its usually 19368, 19357, & 15777, with the appropriate modifiers.