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FASCIOCUTANEOUS LOWER EXTREMITY FLAP WITHOUT IMMEDIATE TRANSFER
I need help with coding the following:
My physician elevated a lower extremity fascio-cutaneous flap. The incision was performed deep to the plantar fascia in order to include the vessel that would then supply this flap. The distal aspect of the remains of the medial plantar artery was ligated and cut. Once adequately elevated, the flap was sutured back into its original site. At this time, it had good capillary refill and was viable.
A few days later, he examined the flap and determined that there was good capillary refill time with perfusion. The flap was further elevated using loupes and tenotomy scissors. A sterile Doppler device was utilize to track the posterior tibial and medial artery tract through the arch of the foot. This was preserved in order to achieve max rotation to cover the foot wound deficit. The flap was further dissected to allow for pivoting motion as well as a tensionless closure. The flap was sutured closed. The flap continued to demonstrate adequate perfusion post rotation, inset and closure. Matriderm skin substitute was applied to the donor site.
Codify CPT 15738 code description states that the flap is created and placed at the site of repair. The physician ensures that the blood vessels are intact, which may involve tunneling the flap under the skin to reach the recipient site. The physician closes the skin of the donor and recipient sites with sutures.
Optum CPT 15738 code description states the physician the physician uses a fascio-cutaneous flap. He then rotates the prepared flap from the donor area to the site needing repair, suturing the flap into place. The donor site is primarily closed with sutures.
Each of the above code descriptors describe a single operative session. There is no instruction provided if the fascio-cutaneous flap was performed in two stages as there is with skin and subcutaneous flaps described in CPT series 15570-15650.
According to CPT ASSISTANT (Pedicled Flaps – Skin and/or Deep Tissues) March 2010 states that CPT codes 15570-15576 are used to report nonadjacent tissue transfers involving skin and subcutaneous tissue and the formation of a direct or tubed pedicle, if performed. These do not include the delay of flap or sectioning of flap (division and inset). The delay or sectioning would be reported with 15600 - 15630 at a separate operative session.
I have researched multiple sources and have found two different answers.
1st SCENERIO:
1st surgery: 15574 (One source stated: while 15738 describes the nature of the flap, the formation itself, with or without transfer, falls under the range of codes 11570-11576). Another source stated: CPT code 15738 encompasses the formation of the flap and the initial transfer to the recipient site. 15738 would not be used when the flap is returned to the donor site. Instead, codes for the delayed transfer and division/inset based on the foot as the recipient site would be used.)
2nd surgery: 15620-58 for the division and inset
2nd SCENEERIO:
1st surgery: 15738-52 (because the flap was only elevated and returned to donor site)
2nd surgery: 15738-58 (without modifier 52 -the flap was re-elevated, divided, transferred and inset)
3rd SCENERIO:
15738-52 (found on google but with no specific guidance)
15620-58 (found on google but with no specific guidance)
Any help or guidance is truly appreciated.
I need help with coding the following:
My physician elevated a lower extremity fascio-cutaneous flap. The incision was performed deep to the plantar fascia in order to include the vessel that would then supply this flap. The distal aspect of the remains of the medial plantar artery was ligated and cut. Once adequately elevated, the flap was sutured back into its original site. At this time, it had good capillary refill and was viable.
A few days later, he examined the flap and determined that there was good capillary refill time with perfusion. The flap was further elevated using loupes and tenotomy scissors. A sterile Doppler device was utilize to track the posterior tibial and medial artery tract through the arch of the foot. This was preserved in order to achieve max rotation to cover the foot wound deficit. The flap was further dissected to allow for pivoting motion as well as a tensionless closure. The flap was sutured closed. The flap continued to demonstrate adequate perfusion post rotation, inset and closure. Matriderm skin substitute was applied to the donor site.
Codify CPT 15738 code description states that the flap is created and placed at the site of repair. The physician ensures that the blood vessels are intact, which may involve tunneling the flap under the skin to reach the recipient site. The physician closes the skin of the donor and recipient sites with sutures.
Optum CPT 15738 code description states the physician the physician uses a fascio-cutaneous flap. He then rotates the prepared flap from the donor area to the site needing repair, suturing the flap into place. The donor site is primarily closed with sutures.
Each of the above code descriptors describe a single operative session. There is no instruction provided if the fascio-cutaneous flap was performed in two stages as there is with skin and subcutaneous flaps described in CPT series 15570-15650.
According to CPT ASSISTANT (Pedicled Flaps – Skin and/or Deep Tissues) March 2010 states that CPT codes 15570-15576 are used to report nonadjacent tissue transfers involving skin and subcutaneous tissue and the formation of a direct or tubed pedicle, if performed. These do not include the delay of flap or sectioning of flap (division and inset). The delay or sectioning would be reported with 15600 - 15630 at a separate operative session.
I have researched multiple sources and have found two different answers.
1st SCENERIO:
1st surgery: 15574 (One source stated: while 15738 describes the nature of the flap, the formation itself, with or without transfer, falls under the range of codes 11570-11576). Another source stated: CPT code 15738 encompasses the formation of the flap and the initial transfer to the recipient site. 15738 would not be used when the flap is returned to the donor site. Instead, codes for the delayed transfer and division/inset based on the foot as the recipient site would be used.)
2nd surgery: 15620-58 for the division and inset
2nd SCENEERIO:
1st surgery: 15738-52 (because the flap was only elevated and returned to donor site)
2nd surgery: 15738-58 (without modifier 52 -the flap was re-elevated, divided, transferred and inset)
3rd SCENERIO:
15738-52 (found on google but with no specific guidance)
15620-58 (found on google but with no specific guidance)
Any help or guidance is truly appreciated.