Wiki "Subcutaneous Flaps" during incisional hernia repair

[TnRushFan]

Hi folks, can I get some opinions please?

One of my surgeons performed open incisional hernia repair.
During closure the fascia retained too much tension so he released fascia from subcutaneous fat to allow less tension on the repair.
He wants to report an adjacent tissue transfer (14301) for the sub-q / fascial release, not sure I agree with him - doesn't that include the skin too?
Would this bundle into main procedure?

Any thoughts or suggestions, please see below basically what he documented.

*hernia defect with subcutaneous advancement flaps
*fascia was tight when testing its ability to close
*additional fascial release was performed by mobilizing subcutaneous flaps from the fascia
*transfascial tacking sutures were placed
*fascia was then closed vertically


Thanks in advance

 

[fwnewbie]

First of all, that is not a tissue transfer - it is just undermining to release the tightened tissue to allow closure. It might qualify for an "extra work" modifier with the surgical note attached.

 

[IndianaJonas]

I found this link and this entire website very helpful for General Surgery Coding. Perhaps this will help you determine if what you are describing is billable.

https://bulletin.facs.org/2017/04/hernia-repair-complex-abdominal-wall-reconstruction/#:~:text=Component%20separation%20involves%20separating%20and,of%20large%20midline%20hernia%20defects.&text=Code%2015734%20is%20an%20open%20procedure.

 

[fwnewbie]

Thanks Indiana for the references. All I have to go on is my experience as an OR scrub nurse and it seems like upcoding for fascial release without muscle layer also involved.

PS I live about 45 miles north of you! Are you enjoying the snow?

 

[IndianaJonas]

It is definitely much more enjoyable now that I work from home!! I love the snow but the cold is a little harsh.

 

[TnRushFan]

Thank you Indiana...your link was very helpful. I was absolutely confident that it was not a tissue transfer but he was insisting on that code.