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9 Cards in this Set
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What does a code for fat grafting include? What if several areas are grafted? |
Similar to skin grafting, fat grafting involves a donor site as well as graft and recipient preparation. Fat is harvested, and donor site is closed and dressed. Fat graft is processed and injected into the recipient site. Fat grafting is reported with code 20926 (tissue grafts, other [e.g., paratenon, fat, dermis]) and includes the following:
Harvest of the fat graft material by any method (e.g., syringe, suction- assisted lipectomy, incision) Closure of the donor site, if indicated, with appropriate dressing Processing of fat graft material Injection of fat graft into recipient site Dressing of recipient site 90 days of routine postoperative care Code 20926 is not anatomical site-specific, nor is it volume dependent. Thus, both the injection of 50 mL of fat into the cheek concavity and injection of 500 mL of fat into the thigh for correction of contour irregularities are coded as 20926. This code is used for each anatomical area injected; thus, if both breasts had fat grafting, the Current Procedural Terminology (CPT) codes would be 20926 and 20926-59, because the second breast is recognized as a separate and distinct procedure. |
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If a skin cancer requires a local flap, how many CPT codes? How is this different for complex closure? |
One, for example: 14040 adjacent tissue transfer or rearrangement cheeks defect 10 cm2 or less excision of a malignant lesion is not separately reportable with codes 14000-14302 If it's a complex closure, the excision of the lesion is a separate CPT from the closure |
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When adjacent tissue transfer is used as a code, how is the area calculated (i.e. What is included)? |
The most appropriate method for calculating the area is to add the area of the defect to the area of the flap. The area of the defect is considered the “primary defect,” and the flap alone is considered the “secondary defect.” It is the combination of these that determines the area on which the current procedural terminology (CPT) codes are based. In this case the defect measures 5 × 10 cm, or 50 cm2. The flap itself measures 20 × 30 cm, or 600 cm2. Therefore, the total area used to assign the correct CPT code is 650 cm2. |
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A 53-year-old woman comes to the office for symmetry revision of a previous breast reconstruction that requires a Ryan flap. The area of advancement is 15 × 4 cm. Which of the following is the most appropriate Current Procedural Terminology (CPT) coding for this procedure? A) 14001 (Advancement flap, 10 to 30 cm2) B) 15734 (Muscle, myocutaneous or fasciocutaneous flap; trunk) and 14301 (advancement flap, 30 to 60 cm2) C) 19380 (Revision of reconstructed breast) D) 19380 (Revision of reconstructed breast) and 14001 (Advancement flap, 10 to 30 cm2) E) 19380 (Revision of reconstructed breast) and 14301 (Advancement flap, 30 to 60
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E is correct. A Ryan flap is not a global component of any of the breast reconstruction codes. The advancement flap procedure is reported separately. The code selected is based upon the surface area of the flap: 14001 (advancement flap, 10 to 30 cm2) or 14301 (advancement flap, 30 to 60 cm2). |
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Which of the following is an example of proper Current Procedural Terminology (CPT) coding when submitting charges for procedures performed? A ) Coding for debridement of a traumatic wound, as well as its complex closure B ) Coding for hernia repair in a transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction due to use of mesh for abdominal wall repair and closure C ) Coding for primary closure of an anterolateral thigh free flap donor site in a lower extremity reconstruction D ) Coding for resection of skin cancer and coding for local small rotation flap to reconstruct E ) Coding for skin grafting to a radial artery free flap donor site in a head and neck reconstruction |
The correct response is Option E.
Based on the CPT manual, skin graft closure of a radial artery free flap donor site is a separate procedure and can be billed separately.
Billing for the complex closure of a traumatic wound includes the debridement of the wound before closure.
Abdominal wall repairs are included in transverse rectus abdominis musculocutaneous (TRAM) flap cases and should not be billed separately.
Anterolateral thigh free flap donor site closure is included in the initial charge for the free flap and should not be billed |
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According to the Centers for Medicare & Medicaid Services, bleeding, intertrigo, pain, and pruritus are all considered complicating pathologies that justify Medicare payment. How does this change coding? |
Icd 10 codes for bleeding, etc must be included along with the Code for the lesion |
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A 73-year-old man with a history of squamous cell cancer of the mid portion of the lower lip undergoes resection and reconstruction with a Karapandzic technique. The flap measures 6 × 2 cm. Which of the following Current Procedural Terminology (CPT) codes is most appropriate for this procedure? A ) 12052 (Repair intermediate, lip 5.1 to 7.5 cm) B ) 13132 (Repair complex, lip 2.6 to 7.6 cm) C ) 14041 (Adjacent tissue transfer, head neck 10.1 to 30 cm2) D ) 15732 (Musculocutaneous flap) |
D is correct The Karapandzic technique is an axial pattern musculocutaneous flap based on the facial artery/vein. The flap is dissected together with its nerve and blood supply and is used to transfer a compound flap of skin and muscle for function repair of lip defects. |
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When coding surgery for an orbital fracture, which of the following is considered a separate Current Procedural Terminology (CPT) code? A ) Elevation of the fracture B ) Exploration of the infraorbital nerve C ) Fixation of the malar fracture D ) Orbital floor exploration E ) Release of entrapment of orbital contents |
C) fixation of the malar fracture Orbital fractures most commonly involve the orbital floor and are often isolated fractures, ie, not associated with other fractures, including those involving the tripod. Although the orbital floor is part of the orbit, a separate series of codes is used to describe procedures for fractures. Each of these codes is global and includes: |
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A patient who has undergone massive weight loss decides to proceed with a medically necessary panniculectomy under Medicare. The procedure is complicated by a wound dehiscence, prompting numerous additional encounters for acute pain management, intensive outpatient wound care, staged suture removal, and eventual scar revision performed in a minor procedure room. In addition to the primary panniculectomy procedure, it is most appropriate for the plastic surgeon to bill for which of the following? A) Acute pain management, including modification of indwelling infusion catheter B) Initial consultation C) Outpatient wound care, including cost of dressings D) Scar revision E) Staged suture removal
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The correct response is Option B. |
