General Surgery Coding Alert

Get ready to dust off the adjacent tissue-transfer coding rules for two new CPT 2010codes -- and Medicare's latest Correct Coding Initiative (CCI) will make sure you do just that.

No sooner did 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm) and +14302 (... each additional 30.0 sq cm, or part thereof [List separately in addition to code for primary procedure]) come on the scene than CCI 16.0 bundled them with a host of other codes. Let our experts help you wade through the edits so you'll know when you can (and can't) bill these codes with other procedures.

Surgeons use adjacent tissue transfer codes (14000-14302) when they perform a complicated closure such as Z-plasty or W-plasty for an excision (such as lesion) or repair (such as laceration).

"Note that the adjacent tissue transfer codes include the excision procedure," says Karen Caputo, CCS-P,certified coder for the University of Toledo Physicians in Ohio.

Rule: According to CPT instruction, you should use 14000-14302 (when appropriate) instead of the following codes for excision and repair:

• Benign lesion excision -- 11400-11471

• Malignant lesion excision -- 11600-11646

• Repair: simple, intermediate, and complex (12001-13152).

That's why CCI 16.0 bundles new code 14301 with each of the preceding codes. Because you'll only use +14302 in addition to 14301 for lesions larger than 60.0 sq cm, the edits effectively also limit your +14302 use.

Good news: "Because the edits enforce proper coding, they shouldn't be a problem -- unless the surgeon performs two separate procedures in one day using closuremethods from the bundled pairs," Caputo says.

For instance: The surgeon removes 42 sq cm tissue for an abdominal wall carcinoma that requires an advancement flap closure. The surgeon also removes another suspicious lesion from the right leg (1.2 cm) that requires simple closure.

You should report 14301 for the abdominal lesion and 11603 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm) for the leg. Append modifier 59 (Distinct procedural service) to 11603 to override the CCI edit pair.

Here's why: For distinct services such as separate body sites, "you can override the edits when CCI lists a code pair with a '1' modifier indicator," says Stacey Hall, RHIT, CPC, CCS-P, RCC, director of corporate coding for Medical Management Professionals Inc. in Nashville, Tenn.

Caution: As with all adjacent tissue transfer codes,only use 14301 if the surgeon creates the configuration intentionally for the repair, not if rearrangement of traumatic wound incidentally results in this closure.

Additional edits: CCI 16.0 also bundles 14301 with other skin codes such as debridement (11040-11042) and subcutaneous biopsy (11100).

Unlike selecting the other lesion excision codes that depend on site and size, 14301 and 14302 depend on size only.

"The 14301 code definition specifies 'any area,' so you should use the code for lesions greater than 30.1 cm from any body site," Caputo says.

Mutually exclusive: Because you should select only one adjacent tissue transfer code for any procedure, CCI 16.0 bundles 14301 with all other codes in the range 14000-14061. Many of these edit pairs are on the "mutually exclusive" edit table. As with other new surgery codes, CCI 16.0 bundles 14301 with a host of procedures, such as intravenous (IV) needle or catheter insertion (36000), that Medicare considers part of the surgical procedure. You'll find a more complete discussion of these bundles in "3 Tips Help You Navigate CCI 16.0 Lap, Excision Limitations."