Wiki Myocutaneous Flap,abdominal wall

[donnaltroy]

I Bill and code for a Surgical practice that specializes in Digestive,Colo-rectal and Neurosurgery and I am perplexed regarding the coding of Myocutaneous Flap of the abdomen and the use of the terms: "Bilateral",LT & RT and the modifier 50.
We are getting denials for using the modifier 50 and/or using LT and RT for abdominal procedures on either side of the trunk. It looks like the Surgeons
can only get paid for one procedure even though it technically is on both sides of the abdomen. Any comments or suggestions are welcome.

 

[egonatas]

Hi, You did not mention which CPT, but 15734 fits your description.

15734 does not allow for modifiers 50, LT, or RT. I would determine that unless the surgeon performed a separate incision and repair, bilateral is not appropriate for the procedure.


15734
Muscle, myocutaneous, or fasciocutaneous flap; trunk

Lay Description

The physician repairs a defect area using a muscle, muscle and skin, or a fasciocutaneous flap. The physician rotates the prepared flap from the donor area to the site needing repair, suturing the flap in place. The donor area is closed primarily with sutures. If a skin graft or flap is used to repair the donor site, it is considered an additional procedure and is reported separately. Report 15732 for a muscle, myocutaneous, or fasciocutaneous flap obtained from the head and neck; 15734 if obtained from the trunk; 15736 if obtained from an upper extremity; and 15738 if obtained from a lower extremity.

 

[lchasteen]

When the physician states bilateral on this procedure , we bill 15734 and 15734 with modifier 76. Repeat procedure.

 

[MI_CODER]

CPT code 15734 may be reported twice for the bilateral mobilization of the rectus muscle. According to Medicare, the bilateral procedure concept does not apply, thus append modifier 59 to the second side to indicate distinct separate procedure. Alternatively, some payors may accept a modifier 51 on the second side. Do NOT use modifier 50.