Revenue Cycle Insider

Question: Our provider repaired a tympanic membrane perforation using both a tragal cartilage graft and a temporalis fascia graft. In addition to the 69631, I want to bill for both grafts with 21235 and 15769, but I have been told I can only bill for the 21235 even though there are no bundling edits. Is this true? Also, if I can bill for the fascia graft, should I use 15769 or 15733?

AAPC Forum Participant

Answer: You are correct in saying that you can bill for both 15769 (Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)) and 21235 (Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)) in addition to 69631 (Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction).

But you can only do so if the surgeon has harvested each graft through a separate incision than the one made to access the tympanic membrane. Per CPT^Ò Assistant Volume 18, Issue 8 (August 2008), “Tympanoplasty procedures may require the use of a graft in order to repair the tympanic membrane. The harvesting of the graft does not warrant a separate CPT^Ò code if the graft was obtained through the same incision used for access to the tympanic membrane or middle ear. Otherwise, a graft harvest code may be reported.”

Additionally, you are correct in saying that 15769 is the preferred code to use in this situation rather than 15733 (Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)). Code 15733 describes a pedicle flap, which the surgeon creates by partially detaching the flap from its muscle, leaving it connected to its original blood supply, and then typically rotating or tunneling the flap into the recipient site without complete excision. In contrast, the surgeon completely excises and transplants a temporalis fascia graft, making 15769 the appropriate code.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC