Lynne77
Contributor
Hello,
I work for a plastic surgeon who was asked to perform a reconstruction after another surgeon removed a large malignant tumor from a patient's left medial knee. The plastic surgeon asked me to code this as a 15738 (muscle flap lower extremity). The payer requested records and denied the claim stating the records don't support the code billed. I'm really struggling to figure out the correct code(s) and I'm thinking this may require a code from the musculoskeletal section??? Can someone please help me?
Here's the note documenting the reconstruction following the tumor removal:
"Initial exam confirmed a very large defect of the left medial knee including an open joint capsule. After hemostasis was confirmed in the wound, an assessment was done. The was exposed vastus medialis with intact fascia, in addition to adductor mangus muscle. Both muscles were mobilized including the accompanying fascia along with wide local undermining. A back cut was made on the adductor mangus fascia to facilitate its medial movement to complete the closure of the capsule. 0 Vicryl figure-of-eight sutures were used to repair the muscle primarily including closure of the opening in the knee joint. Prior to final closure of both muscle flaps, a #15-French round drain was placed between the muscle and the bone and brought out into the undermined skin flaps then through an incision lower down on the proximal calf. After hemostasis was confirmed again, a small amount of skin was noted to be injured on the distal knee and was resected to facilitate the closure. Next a multi-layer closure was done with deep interrupted 2-0 Vicryl on Scarpa's fascia, followed by deep dermal 3-0 Monocyrl, followed by running subcuticular 4-0 Monocryl. The drain was secured to the skin with a 4-0 nylon. Total length of the defect closure was 16 cm. The PICO wound management system was then applied and the remaining dressings on the drain were placed.
Any help anyone can give is GREATLY appreciated!
I work for a plastic surgeon who was asked to perform a reconstruction after another surgeon removed a large malignant tumor from a patient's left medial knee. The plastic surgeon asked me to code this as a 15738 (muscle flap lower extremity). The payer requested records and denied the claim stating the records don't support the code billed. I'm really struggling to figure out the correct code(s) and I'm thinking this may require a code from the musculoskeletal section??? Can someone please help me?
Here's the note documenting the reconstruction following the tumor removal:
"Initial exam confirmed a very large defect of the left medial knee including an open joint capsule. After hemostasis was confirmed in the wound, an assessment was done. The was exposed vastus medialis with intact fascia, in addition to adductor mangus muscle. Both muscles were mobilized including the accompanying fascia along with wide local undermining. A back cut was made on the adductor mangus fascia to facilitate its medial movement to complete the closure of the capsule. 0 Vicryl figure-of-eight sutures were used to repair the muscle primarily including closure of the opening in the knee joint. Prior to final closure of both muscle flaps, a #15-French round drain was placed between the muscle and the bone and brought out into the undermined skin flaps then through an incision lower down on the proximal calf. After hemostasis was confirmed again, a small amount of skin was noted to be injured on the distal knee and was resected to facilitate the closure. Next a multi-layer closure was done with deep interrupted 2-0 Vicryl on Scarpa's fascia, followed by deep dermal 3-0 Monocyrl, followed by running subcuticular 4-0 Monocryl. The drain was secured to the skin with a 4-0 nylon. Total length of the defect closure was 16 cm. The PICO wound management system was then applied and the remaining dressings on the drain were placed.
Any help anyone can give is GREATLY appreciated!