Wiki cpt code 15757 vs cpt code 40845

[jocoffey]

Hi, can anyone enlighten us on these 2 codes, the ins. co is saying they are inclusive of each other. They are both for reconstruction surgery, but

how are they bundled? any help would be appreciated.

 

[jackjones62]

I did not find any CCI Edits re: 15757 and 40845; 15757 is a free skin graft w/microvascular anostomies and 40845 is a vestibuloplasty that sometimes requires soft tissue grafting from another area;
was the free skin graft used for the vestibuloplasty??? if so, are you sure the skin graft required microvascular anostomies? or was it just a split or full thickness skin graft? Or, is the graft and vestibuloplasty totally separate? if so, Modifer XS would be appropriate.....need a little more info on this situation.

Jennifer
IN ENT

 

[jocoffey]

15757 vs 40845

I did not find any CCI Edits re: 15757 and 40845; 15757 is a free skin graft w/microvascular anostomies and 40845 is a vestibuloplasty that sometimes requires soft tissue grafting from another area;
was the free skin graft used for the vestibuloplasty??? if so, are you sure the skin graft required microvascular anostomies? or was it just a split or full thickness skin graft? Or, is the graft and vestibuloplasty totally separate? if so, Modifer XS would be appropriate.....need a little more info on this situation.

Jennifer
IN ENT

Hi Jennifer, our md says 15757 was the harvesting of the free flap and the microvascular anastomosis with inset. The free flap tissue was then used to create a vestibule of the mouth which is the 40845-complex vestibuloplasty. The insurance co is saying these are inclusive. However, the free flap is taken from the forearm, and then used to create the vestibule of the mouth. ??????? Thanks

 

[jackjones62]

Who is the insurance company? I would argue that according to CMS, there are no CCI Edits pertaining to these two codes and they are using inappropriate bundling of these two services and demand a review by a Board Certified Otolaryngologist. Here is the Encoder's interpretation of CPT 40845:

40845
Vestibuloplasty; complex (including ridge extension, muscle repositioning)

Lay Description (Code):

The surgeon performs a vestibuloplasty and deepens the vestibule of the mouth by any series of surgical procedures for the purpose of increasing the height of the alveolar ridge, allowing a complete denture to be worn. The vestibule refers to the mucosal and submucosal tissue of the inner lips and cheeks, the part of the oral cavity outside of the dentoalveolar structures. This procedure is performed for complex cases, such as those in which the physician must lower muscle attachments to provide enough space for deepening the vestibule. Soft tissue grafting from other areas of the body into the mouth is often required. Hypertrophied and hyperplastic tissue may need to be trimmed and soft tissue revised by dissecting it from the alveolar ridge and rearranging its attachment.

Coding Tips

When 40845 is performed with another separately identifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with modifier 51. If significant additional time and effort is documented, append modifier 22 and submit a cover letter and operative report. Report any free grafts or flaps separately, see 15120, and 15240. Local anesthesia is included in the service. For anterior vestibuloplasty, see 40840. For posterior vestibuloplasty, unilateral, see 40842; bilateral, see 40843. For vestibuloplasty of the entire arch, see 40844.

Jennifer
IN ENT

 

[jocoffey]

15757 vs 40845

Jennifer,

The payer is anthem medicare. Thank you so much for your input. This was a complex case. Also this pt has had several complex

surgeries due to malignant cancer of mouth and mandible.