Wiki Rotation Flap Billing Question

[JFoushee12]

Can you bill 2 separate rotation flaps on the same defect or do you just add them together? For clarification, that is 2 separate secondary defects for the same primary defect???? See provider notes below.

Lesion Location: left anterior ala
Reason for Removal: pathology confirmed malignancy
Repair: rotation flap x 2 elected to preserve normal anatomy - superior flap corrected defect on the left nasal tip and the inferior flap was used to correct the defect on the L ala
Size of Flap: superior flap - 2.5cm squared including primary and secondary defect. Inferior flap 3.0cm squared including primary and secondary defects
Deep Layer Sutures: 5-0 monocryl buried
Skin Layer Sutures: 5-0 monocryl running, 5-0 monocryl interrupted
EBL: Minimal

I know if there is a graft or a rotation flap required on the secondary defect you can bill it. . . but both of these flaps are on the primary defect.

Look forward to seeing what you think. I cannot find anything specifically addressing 2 rotation flaps on the same primary lesion/defect. Thanks! Janelle

 

[ABonnell CPC]

I do not have any articles to reference, but I would bill for 2 separate flaps. Because of the nasal anatomy, etc...1 flap could not be used to reconstruct both part of the nose, even though it was create by just one lesion.

 

[CatchTheWind]

I also have no reference, but my expectation would be that you would have to add up the square cm. of all three sites and bill as a single flap.

My logic comes from the rule for billing bilobed flaps (when a third - also contiguous - site is used as a flap to repair the second site). In that case, you have to bill as a single flap (adding up all the sizes together). I can't recall my source for that, but I know that I had researched it and that this is a definitive rule.

 

[Texascoder64]

I agree with adding together all 3 areas - this will more than likely be a larger flap using the cpt code 14301 30.1 - 60 sq cm , and for each add'l 30 sq cm use cpt 14302(with appropriate units)