Documentation Requrements for Myocutaneous/Fasciocutaneous Flap (15732)

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Hello, I am hoping someone can help me. I work for a dermatology office that does a lot of Mohs procedures...We have a plastic surgeon that will perform the appropriate closure/repair post Mohs. Only recently some of the commercial insurances (UHC & Aetna) have been denying CPT code 15732 stating the documentation does not support the services billed or they are down coding my claim to an adjacent tissue transfer CPT code 140_ _. The only explanation they have given me is " just because a skin flap contains deep muscle fascia does not make it a myocutaneous/fasciocutaneous flap. Medicare and all other insurances have been paying with no issue. I have done tons of research & I am trying to find out if anyone knows where I can find the medical necessity/ documentation requirements for CPT code 15732. Our documentation is clear & sufficient , it even names the muscle/fascia and has it's own vascular source, I feel CPT code 15732 is most appropriate!! I don't know what I'm missing & I just don't know what they are looking for??? Can anyone offer any advise, or suggestions ? Can you please provide resources to information found ? Attached is an example of an op note below ..... Thank you in advance to anyone that can help me!!! ;)

Repair Note:
Assistants: S
Location: Left nose
Referring Provider: Dr. J
Repair Type: Flap
Anesthesia: local anesthesia and local infiltration-1% lidocaine with epinephrine(3 cc)
Hemostasis: electrocautery
Flap Type: Bilobed Flap
Primary Defect Dimensions and Area: 0.9 cm x 1.3 cm = 1.17 cm2
Secondary Defect Dimensions and Area: 3 cm x 3 cm = 9 cm2
Total Repair Area: 10.17 cm2
Estimated Blood Loss: minimal
Complications: none
The rationale for Repairs was explained to the patient and consent was obtained. The risks, benefits and
Alternatives to therapy were discussed in detail. Specifically, the risks of infection, scarring, bleeding, prolonged
wound healing, incomplete removal, allergy to anesthesia, nerve injury and recurrence were addressed. Prior to
the procedure, the treatment site was clearly identified and confirmed by the patient. All components of Universal
Protocol/PAUSE Rule completed. The area was prepped with antiseptic solution. The choice of the repair was
performed to avoid a deforming, depressed, and contracted scar, to close large gap created by lesion removal,
and to reduce tension to enhance both functional and cosmetic results. Dorsal Nasal Myocutaneous Flap - 15732
Given the size, location, and depth of the defect and the proximity to free margins a dorsal nasal myocutaneous
flap, with procerus nasalis muscle, was deemed most appropriate. Using a sterile surgical marker, an appropriate
dorsal nasal flap was drawn around the defect, and extended superiorly to the glabellum. The area thus outlined was incised deep to adipose
tissue, procerus and nasalis muscles with a #15 scalpel blade. The myocutaneous flap was elevated in the submuscular plane based on a branch
of the angular artery. It was then rotated into position to close the defect without tension and with a normal contour. The dermal sutures were 4-0
Vicryl. Epidermal closure was achieved with 5-0 Fast Absorbing Gut (running). Polysporin ointment + dry sterile dressing were applied. I reviewed
with the patient in detail post-care instructions. Patient is not to engage in any heavy lifting, exercise, or swimming for the next 14 days. Should the
patient develop any fevers, chills, bleeding, severe pain patient will contact the office immediately.
 
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Did you appeal with op note?

Did you appeal with the op note attached, and relevant information HIGHLIGHTED?
I agree with you that the procedure description supports the myocutaneous flap.

F Tessa Bartels, CPC, CEMC
 
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Did you appeal with the op note attached, and relevant information HIGHLIGHTED?
I agree with you that the procedure description supports the myocutaneous flap.

F Tessa Bartels, CPC, CEMC

Yes, and I have had strong appeals highlighting & spelling it all out for them. UHC still denied with "decision upheld- documentation does not support services billed" or Aetna will say " just because a skin flap contains deep muscle fascia does not make it a myocutaneous/fasciocutaneous flap." The only thing I found through Inga Ellzey, a big dermatology consultant, is they suggested that 15732 may apply to the deep or major muscles as apposed to the minor muscles. So I was trying to figure out if anyone knew/ could point me to exact guidelines or documentation requirements to see if I can fight these denials. I always like to add supporting documentation to my spelled out op notes. My last resort would be to possibly do a peer to peer review to see what they tell my physician, but I don't like to involve them unless I absolutely have to.

Danielle Arcadi CPC
 

walshe

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15732

This is the information I have found regarding the code 15732- this is a code for a more extensive procedure. This is from Plastic Surgery News Magazine

Flap reconstruction
A 6 mm basal cell carcinoma of the nose is
excised with 2 mm margins, and the defect
reconstructed with a rhomboid flap, which
includes a portion of the nasalis muscle.

15732 Myocutaneous flap
11641 Wide excision of basal cell
12051 Closure of flap donor site

This procedure has been upcoded and
unbundled. Just because a flap includes muscle
tissue does not qualify it as a muscle or
myocutaneous flap to be reported with code
15732. The muscle flap codes (1573X)
describe extensive procedures comprising
muscle dissection, disorigination and/or
disinsertion, dissection and preservation
of vascular pedicle, and transfer. Code 15732
is used to report muscle flaps such as the
temporalis or sternocleidomastoid, not an
adjacent tissue transfer which includes some
muscle tissue.
This procedure should be reported with
code 14060 alone, which includes excision of
the skin lesion, as well as closure of the
donor site.
 
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