I have a plastic surgeon who wants to bill adjacent tissue transfer codes in addition to 19357 (breast reconstruction with tissue expander) when he does de-epithelialized dermal flaps. Does anyone know if that is appropriate? Please see portion of operative dictation:
Following the mastectomies, the operative field was reprepped and draped in a sterile fashion. The right side was addressed. Initially, the pocket was irrigated with antibiiotic solution. The lateral border of the pectoralis major muscle was identified and elevated up off the chest wall and its inferior attachments were released to approximately the mid sternum utilizing bovie cautery. Hemostatis was obtained throughout utilizing insulated forceps and the bovie cautery. Once adequate pectoralis release had been obtained, the area previously marked for de-epithelialization along the inferior mastectomy flap was deepithelialized utilizing a #15 blade. This was the inferior aspect of the initially marked Wise pattern. The total flap dimensions were 20 x 7 cm. After this area was deepithelialized, the flap was dissected free from the medial and lateral components of the mastectomy flaps and sutured to the lateral mammary fold and the inframmmary fold utilizing 2-0 vicryl sutures. It was also sutured to the inferomedial and superolateral pectoralis major utilizing multiple interruped 2-0 victry sutures. The wound was thoroughly irrigated frequently with antibiotic solution and hemostasis was adequate. The pocket dimensions were analyzed and a 15 french draing was then placed deep to the pectoralis and deepithelialized flap and a second draing in the subcutaneous plane and both were secured with 3-o nylon suture.
The report goes on to describe the insertion of the tissue expanders...
so my question is should the adjacent tissue transfer codes be used to report the creation of these deepitheliazied flaps or is that work included in the 19357 code? I have the opinion of two other coders who think it should be included in the 19357, however they freely admit they do not have much experience in plastics coding.
Thank you!
New to Plastics
Following the mastectomies, the operative field was reprepped and draped in a sterile fashion. The right side was addressed. Initially, the pocket was irrigated with antibiiotic solution. The lateral border of the pectoralis major muscle was identified and elevated up off the chest wall and its inferior attachments were released to approximately the mid sternum utilizing bovie cautery. Hemostatis was obtained throughout utilizing insulated forceps and the bovie cautery. Once adequate pectoralis release had been obtained, the area previously marked for de-epithelialization along the inferior mastectomy flap was deepithelialized utilizing a #15 blade. This was the inferior aspect of the initially marked Wise pattern. The total flap dimensions were 20 x 7 cm. After this area was deepithelialized, the flap was dissected free from the medial and lateral components of the mastectomy flaps and sutured to the lateral mammary fold and the inframmmary fold utilizing 2-0 vicryl sutures. It was also sutured to the inferomedial and superolateral pectoralis major utilizing multiple interruped 2-0 victry sutures. The wound was thoroughly irrigated frequently with antibiotic solution and hemostasis was adequate. The pocket dimensions were analyzed and a 15 french draing was then placed deep to the pectoralis and deepithelialized flap and a second draing in the subcutaneous plane and both were secured with 3-o nylon suture.
The report goes on to describe the insertion of the tissue expanders...
so my question is should the adjacent tissue transfer codes be used to report the creation of these deepitheliazied flaps or is that work included in the 19357 code? I have the opinion of two other coders who think it should be included in the 19357, however they freely admit they do not have much experience in plastics coding.
Thank you!
New to Plastics