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Latissimus Dorsi Myocutaneous Flap of Face

Denise Posted Wed 10th of July, 2019 16:55:17 PM
I am in need of help! My doctor did the following procedure: Reconstruction right neck, right mandible, right side of the face, and the lower lip. Latissimus Dorsi myocutaneous flap rotation with a release of contracture in the right cheek. Rotation of lower lip to close defect. He came in as the reconstructive doctor of a patient that had large right side face and neck defect following squamous cell carcinoma excision from the anterior floor of mouth. I have found the codes 14040 - L90.5, C04.9 but Cfeel there should be another code. Also, when put in supercoder it states the C04.9 does not match the cpt code. Please help!
SuperCoder Answered Thu 11th of July, 2019 08:14:47 AM

Hi Denise,

Code with the range between CPT 15733 to 15736, depending on the area involved.  As per above documentation appropriate code seems to be 15734, reason being Latissimus dorsi is in the upper back (thoracodorsal region). Also, extensive immobilization and/or repair of the donor site is reported separately. Feel free to ask for any further query.

NOTE:

In myocutaneuos flap physician uses muscle, muscle and skin.

In ATT only skin rearrangement is done like M-plasty, Z-plasty. 

Denise Posted Thu 11th of July, 2019 15:54:31 PM
He took the muscle from the back. and used it to reconstruct the neck and right side of face. Please I am new to this type of coding and need help. What would you use for repair of the donor site.
SuperCoder Answered Fri 12th of July, 2019 10:07:02 AM

Hi Denise,

For repair of donor site, we will see documentation for the technique used. for microvascular flaps, see (15756-15758), for flaps without inclusion of a vascular pedicle, see (15570-15576). for adjacent tissue transfer flap, see (14000-14302).

Also, A repair of a donor site requiring a skin graft or local flaps is considered an additional separate procedure. Simple repair is inclusive of primary procedure performed.

As per above documentation it seems provider is using adjacent tissue transfer flap so we will see from code range (14000-14302). You will use code 14000 or 14001, as donor site is getting repaired, however, check for the sq cm being repaired. 

So you should report 15734 (Muscle, myocutaneous, or fasciocutaneous flap; trunk) for recipient site and adjacent tissue transfer code such as 14000 (Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less) or 14001 (... defect 10.1 sq cm to 30.0 sq cm) for donar site depending on the defect size. Hope it helps.

NOTE:

It's strongly recommended that each coder who uses CPT codes 15732-15738 highlight the notation regarding the coding from donor site. Interestingly enough, in reviewing CPT, the AMA has never addressed the question about using only donor sites for these four codes. This is the type of topic coders can continually debate, but they have an obligation to decide whether a code is appropriate. The final outcome can only come during an audit or in reviewing codes with your physician.    The key to coding correctly and avoiding an audit is physician documentation -- they must provide adequate information in their dictation or hand-written notes. 

Denise Posted Wed 11th of September, 2019 16:47:37 PM
This might be a separate question but relates to the above information My doctor did a nd surgery of which he did a right trapezius myocutaneous flap Split-thickness skin graft to the donor site Rotation of the flap Reconstruction of the right neck Reconstruction of soft tissue right mandible Release...
SuperCoder Answered Thu 12th of September, 2019 11:06:10 AM

Hi Denise,

Since this is a seperate question, you have to put this query in a new thread. Thank you.

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