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Tissue Rearrangement with Incarcerated Epigastric and Umbilical Repair

Camille Posted Tue 03rd of December, 2019 15:16:31 PM
Codes: 49572, 49587, 14000. The surgeon performed separate, open, incarcerated epigastric and umbilical hernia repairs. Question: Is 14000 reportable with these repairs? Excerpt from Op Note: "Both defects were then closed with interrupted figure of eight 2-0 Prolene sutures. The subcutaneous tissue was then closed over the fascia with 3-0 Vicryl sutures to close the potential seroma space. The measured amount of tissue exchange was 10 cm2. Local anesthetic was infiltrated. the subcutaneous tissue was closed with an additional layer of 3-0 Vycril, and the skin was close with 4-0 Monocryl. Steri-Strips and sterile dressing were applied." Thank you!
SuperCoder Answered Wed 04th of December, 2019 09:56:45 AM



The most important component of knowing when and where to apply adjacent tissue transfer codes is the ability to identify them in an operative note. Specifically, you want to make sure you identify within the operative report a relocation of a "flap" of healthy skin from a donor site to the closure site. What makes adjacent tissue transfer coding even trickier is that you may have to look out for different terms that are synonymous with adjacent tissue transfer closer. Some of these terms include:

  • Z-plasty, W-plasty, V-Y-plasty;
  • Rotation and advancement flaps;
  • Bilobed flaps;
  • Rhomboid flaps; and
  • Double pedicle flaps.

As per the given report, there is no appropriate documentation which qualifies for ‘Adjacent tissue transfer or rearrangement’ procedure, so it is suggested not to code CPT 14000. However, hernial repair codes also includes incision closure.


Hope this helps!





Camille Posted Wed 04th of December, 2019 15:23:45 PM
Great direction, thank you! Will you please confirm or correct my thinking? If the documentation did support the work described in CPT 14000, it still should not be coded with the hernia repair, as closure is included in the open hernia repairs.
SuperCoder Answered Thu 05th of December, 2019 08:23:56 AM



As per CCI edits, you can bill CPT 14000 with 49572 and 49587, but there should be a medical necessity for performing CPT 14000 code in operative report. If physician documents in operative report that he performed tissue rearrangement or transfer than you can bill CPT 14000.

If physician only closing the incision which is created for procedures 49572 and 49587 than these defects will be consider inclusive in their respective CPT codes.

Please check your documentation carefully as dollar value of CPT 14000 is quite higher than CPT 49572 and 49587.



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