Nathan Posted Sat 08th of February, 2020 19:29:49 PM
I did the first stage of an interpolated midface nasolabial cheek-to-nose flap preserving vascular branches of the angular artery and fibers of both levator and orbicularis oris muscles WITHIN the pedicle. In addition I harvested a cartilage graft from the ipsilateral conchal bowl. My colleague says to code a 14041 with 21235 however it appears to me that I meet the criteria for 15730 and 21235. Can you clarify relative to this specific case how I would decide between 15730, 15576, and 14041? Also is 21235 correct and what modifiers are necessary?
Nathan Posted Mon 10th of February, 2020 02:03:45 AM
Please do not comment on 14041. The procedure was NOT an adjacent tissue transfer and therefore the code is inappropriate.
SuperCoder Answered Mon 10th of February, 2020 03:16:30 AM
Thanks for your question.
Code 14041 is for ATT (Adjacent Tissue Transfer) in which the provider replaces the lesions with the healthy tissues from an adjacent site. In this code no preservation of vascular pedicles is performed. Codes 14000-14350 are for the excision (including lesion) and/or repair, by adjacent tissue transfer or rearrangement (eg, Z-plasty, W-plasty, V-Y plasty, rotation flap, island pedicle flap, advancement flap).
In code 15730, the provider creates a zygomaticofacial flap of skin from the midface of the patient to treat injury or open wounds on the face or scalp. He rotates the flap, complete with vascular supply, to cover the defect.
In code 15576, provider prepares a direct or tubed pedicle flap to cover a wound. A pedicle flap is a portion of skin and subcutaneous tissue raised from its bed at one end and moved to another part of the body while one end (the pedicle) remains attached to its original blood supply at the donor site. CPT codes 15570-15576 are used to report nonadjacent tissue transfers.
Now as per the limited documentation, code 15730 seems correct since preservation of vascular branches is maintained while doing midface nasolabial cheek-to-nose flap.
Graft is taken from conchal bowl. So, code 21235 is also correct to report with 15730.
Please feel free to write if you have any question.
Nathan Posted Mon 10th of February, 2020 03:36:13 AM
Thank you for the quick response.
SuperCoder Answered Mon 10th of February, 2020 23:33:36 PM
Thank you, happy to help.