Question Need coding guidance for PROCEDURE: Left Immediate Oncoplastic Breast Reconstruction with Tissue Expander and ADM, Adjacent Tissue Transfer

[unagarkar1]

Can we bill 19357 -50 , 15777 - 2 units , 14301 , 14302 - 14 units together when op report mentions - The patient was re-prepped with chlorhexidine and new sterile towels were used to re-drape the operative field. An inferior based dermal pedicle flap was used in the reconstruction. This skin flap inferior to the former nipple-areolar complex to the level of the inframammary fold was de-epithelialized and measured approximately 26 x 18 cm. This skin flap which normally would have been discarded was preserved in an effort to rearrange the existing breast tissue to provide contour, shape and an overall more aesthetic reconstructive result. This technique of preserving this flap for reconstruction is separate and distinct from the placement of the tissue expander. Therefore, the total area of adjacent tissue transfer was 468 cm squared. The wounds were irrigated and hemostasis was achieved with electrocautery.
PROCEDURE:
Left Immediate Oncoplastic Breast Reconstruction with Tissue Expander and ADM, Adjacent Tissue Transfer (468 cm squared)

 

[apoland]

Hello,
The ASPS has spoken about adipodermal flaps during their yearly coding conferences and have confirmed the use of 14301/14302 for these. The flap measurement should be of the de-epithelielized portion only. The MUE for 14302 is only 8, but in a few select situations we have had success appeal the mue denial with documentation support.
Good luck!