64721 with 15736 (Plastic surgeon doing general ortho)

abaer01

Contributor
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Melrose, FL
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I have a doctor that had 15736 (Muscle, myocutaneous, or fasciocutaneous flap; upper extremity) deny when billed with 64721 (Neuroplasty and/or transposition; median nerve at carpal tunnel).

The reason for reporting 15736 is to prevent scar tissue formation at the site of the carpal tunnel release and the flap was taken from over the hypothenar muscles of the hand. He documents harvesting of the flap by naming the vascular structure, but occasionally does not document closure of the secondary defect, specifically when billed with carpal tunnel releases.

This same surgeon bills 15736 for similar reasons for Dupuytren's excisions 26123 & 26121 that also deny due to NCCI bundling edits.

Can someone please let me know if billing pedicle flap procedures done during these routine ortho procedures on the hand is or can be substantiated? I'm concerned that this doctor bills these flap codes because he is accustomed to doing so as a plastic surgeon, but they may not be appropriate to report when done during routine ortho procedures.
 
Last edited:

nickelclaw

Networker
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Location
Peru, IN
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Hello,
It is rare that I see this done will your procedures. There is no NCCI edit 64721/15736 and this would be correct due to documentation of vascular structure he is removing from. Closure of defect is included in the harvest.

If documentation supports the 15736 I would add modifier XU.
The reason this is rubbing is due to the 26121/ 26123 includes the rearrangement/advancement of skin graft. Since the 15736 is not a skin graft BUT A FLAP you may bill together:)
 
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