General Surgery Coding Alert

Question: If the surgeon excises a 2 x 4 cm carcinoma of the face, and closes the excision using adjacent tissue transfer, should we report 10404 and 11643?

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Answer: No. You should report only 14040 (Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; defect 10 sq cm or less).

Here’s why: The tissue transfer code includes the lesion excision (11643, Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm).

Exception: There is one exception to this coding scenario. If your surgeon performed the excision on an earlier day from the tissue transfer, you may report the procedures separately. This may have occurred, for example, if the doctor wanted to wait for the pathology report to be sure the margins are clear before closing the operative wound.

Caveat: If the tissue transfer occurred during the excision’s 10-day global period, you must append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to the tissue transfer code (14040).