Is this an adjacent tssue transfer or complex closure?


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I work for a fascial plastic surgeon who does a lot of reconstruction with advancement flaps.

He argues that if he does extensive undermining and soft tissue advancement flap reconstruction then it qualifies as an adjacent tissue transfer.

I thought that in order to qualify for an adjacent tissue transfer that additional incision(s) need to be made and that without additional incisions, these would be coded as complex repairs.

Here is a sample dictation. (in this scenario, he has already completed a full-thickness excision - which I realize is included in an ATT or would be reported separately with a complex repair)

]"... the overall size, shape and anatomic location of this large wound/defect in a 12 yr old girl made it impossible to perform primary approximation without excessive tension at the suture line and probable widening of the scar in the postoperative period. As was discussed preoperatively, attention was therefore directed toward extensive undermining and bilateral soft tissue advancement to achieve closure, i.e. adjacent tissue transfer reconstruction.

Utilizing double prong skin hooks and curved iris scissors, undermining of the skin of the left lower eyelid, left upper cheek, left malar cheek and left temple areas was performed for a distance of approximately 3 to 5 cm in all directions in the mid subcutaneous plane. All bleeding was arrested with electrocautery. Multiple interrupted 3-0 Vicryl sutures were then placed through the deep subcutaneous tissues in a manner so as to essentially imbricate these soft tissues, which not only decrease the overall dead space, but brought the cutaneous margins in closer approximation. Multiple interrupted 3-0 Vicryl sutures were utilized in this regard.

Secondly, multiple interrupted 3-0 Vicryl sutures were placed from the deep margins of these advancement flaps to the underlying deep subcutaneous tissues at multiple points along the length of both of the advancement flaps in a manner so as to advance the soft tissue flaps towards one another and to distribute the tension along the length of the soft tissue flaps rather than at the suture line. This also served to minimize the possibility of fluid accumulation/hematoma beneath the soft tissue flaps in the postoperative period. Multiple interrupted 3-0 Vicryl sutures were utilized in this reagrd.

Following undermining, advancement and fixation of the soft tissue flaps, multiple interrupted 3-0 Vicryl, 4-0 Vicryl and 5-0 Monocryl sutures were placed in the deep, mid and superficial subcutaneous planes, respectively. A running intracuticular 6-0 Prolene suture was placed in a classic fashion along the incision line. SO as to futher ensure meticulous approximation of the wound edges, a running interlocking suture was similarly employed..."

I'd appreciate input on whether this is an adjacent tissue transfer or complex closure.
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According to the Conference I went thru Karen Zupko ....In general undermining and advancing would be a complex repair.

In order to bill an ATT you would actually need to create (cut) some sort of flap which is moved.
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Adjacent tissue flap v complex closure

If the surgeon CREATES the flap, you can charge the adjacent tissue flap code. Otherwise, you charge the complex closure code. Furthermore, even if you have a wound defect that is in the "shape" of an adjacent tissue flap (eg. Z-plasty) that the surgeon did NOT create but must be brought together, you can only charge the complex closure.


Murrieta, California
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Advancement flap, adjacent tissue transfer or complex closure

To hlth4513-

You would use the CPT code for ATT for the op report you posted here. Your surgeon created the flaps, he happened to undermine, cut and move the tissue.