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14061 or 15733 or 15730

Nathan Posted Tue 04th of June, 2019 03:10:37 AM
I performed a NON-adjacent tissue transfer from the cheek to the nose. I cut a direct pedicle flap of 6.3 x 2.1cm, dissect out branches of the angular artery and fibers of obicularis muscle and meticulously ensure that they remain attached to the pedicle of the flap. I transfer the paddle to a 2.1 x 2.8cm nose defect and then perform a delayed division and inset on it 3 weeks later. According to your article, "CPT® 2018: Update How You Report Deep-Tissue and Facial Pedicle Flaps" the 15730 is for ONLY the zygomaticofacial vessel pedicle flap. The article states that the CPT definition of 15733 code allows for other named vascular pedicles (except the paramedian forehead flap) stating, "the list in the code definition is not exhaustive, it just lists examples." However, in your article "CPT® Assistant April 2018; Volume 28: Issue 4" you state, "Code 15730 describes midface flaps (smaller and not based on a named vascular pedicle), while code 15733 describes muscle flaps of the head and neck (larger and based on a named vascular pedicle). It is important to note that the vascular pedicles (namely the buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae) listed in code 15733 are the only vascular pedicles that apply when reporting this code." Based on my scenario and the new 2018 rules, which is the proper code? And what are the minimum criteria required to code the 15730? Thanks again for all the great help!
SuperCoder Answered Thu 06th of June, 2019 09:22:19 AM

Thanks.

SuperCoder Answered Thu 06th of June, 2019 10:15:01 AM

Hi Nathan,

Our team is working on this query and will reply you soon.

Thanks.

SuperCoder Answered Fri 07th of June, 2019 07:47:23 AM

Hi Nathan,

Thanks for your question.

A flap containing the underlying muscle layer is called a myocutaneous or muscle flap and a flap with the fascia is called a fascial or fasciocutaneous flap and as per documentation provided it appears code 15730 is the code of choice to use in this scenario, since the procedure was performed at the area involving orbicularis oculi muscle and zygomaticus bone. Anatomic proximity of the created flap with the involved area lead us towards CPT® code 15730.

The criteria required to use CPT® code 15730 requires that the vascular supply is preserved, and the pedicle flap is created from zygomaticofacial tissues (structures around the highest part of the cheek and the temporal area of the face). A vascular pedicle flap consists of the full thickness of the skin and the subcutaneous tissue, attached by tissue through which it receives its blood supply.

Hope this helps.

Thanks.

Nathan Posted Sat 08th of June, 2019 22:27:45 PM
That is a big help. Thank you for the complete and thorough response to my question.
SuperCoder Answered Mon 10th of June, 2019 02:01:12 AM

Thank you, happy to help.

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