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Wiki nasal stenosis repair and advancement flaps
ljones88
Networker
Hey,
Without the op note I can't say for sure. However, to me it would seem odd to report those two together (unless the physician is doing the tissue transfer for something unrelated to 30465). A few of our physicians perform 30465 quite often and I've never seen them also perform an adjacent tissue transfer during the same surgery. I've reached out to one our physicians whose well versed with this type of surgery to ask his opinion on this. In 2015 alone he performed 30465 on 111 cases and none of them required adjacent tissue transfers.
To formally answer the question, NCCI/CPT does not bundle the two. However, if the physician is referring to the spreader graft or cartilage graft as separately reportable pay attention to the incision site. If the graft is harvested from the same incision site, it would be included in 30465. If the physician is making a separate incision somewhere else to obtain a cartilage graft than they can bill for harvesting the graft.
Without the op note I can't say for sure. However, to me it would seem odd to report those two together (unless the physician is doing the tissue transfer for something unrelated to 30465). A few of our physicians perform 30465 quite often and I've never seen them also perform an adjacent tissue transfer during the same surgery. I've reached out to one our physicians whose well versed with this type of surgery to ask his opinion on this. In 2015 alone he performed 30465 on 111 cases and none of them required adjacent tissue transfers.
To formally answer the question, NCCI/CPT does not bundle the two. However, if the physician is referring to the spreader graft or cartilage graft as separately reportable pay attention to the incision site. If the graft is harvested from the same incision site, it would be included in 30465. If the physician is making a separate incision somewhere else to obtain a cartilage graft than they can bill for harvesting the graft.
ljones88
Networker
I spoke to one of our physicians who performs 30465 often. When I asked if it is common to do an advancement flap with 30465, he explained the below. So I'm going to safely assume if the physician's documentation is clearly there, I would bill for the advancement flaps.
___________________________________________________
From: Mark Agrama
Sent: Tuesday, February 16, 2016 5:27 PM
To: Lisa Jones
Subject: Re: Repair of nasal vestibular stenosis with adjacent tissue transfer
Lisa,
There are many possible secondary grafts and procedures that can be performed with 30465. My current technique avoids using secondary sites for graft, instead reconstructing the integrity of the nasal valve with suturing and the creation of an intravalve pocket which enables scar formation and increased valve integrity. Spreader grafts can be helpful, but they are an example of one of the techniques, not essential for the procedure.
Thank you,
Mark Agrama, MD
___________________________________________________
From: Mark Agrama
Sent: Tuesday, February 16, 2016 5:27 PM
To: Lisa Jones
Subject: Re: Repair of nasal vestibular stenosis with adjacent tissue transfer
Lisa,
There are many possible secondary grafts and procedures that can be performed with 30465. My current technique avoids using secondary sites for graft, instead reconstructing the integrity of the nasal valve with suturing and the creation of an intravalve pocket which enables scar formation and increased valve integrity. Spreader grafts can be helpful, but they are an example of one of the techniques, not essential for the procedure.
Thank you,
Mark Agrama, MD