Sorry if I have missed this in a previous post but our docs are doing delayed TRAM flaps. Suprapubic incisions are made and dissection carried down through the fascia and vessels that supply the muscles that will become the TRAM flap are ligated. This is done to improve the other vasculature of the future flap. This is in an OUTPT setting. I am not sure if we code this as a TRAM with a 58 modifier or what. Thanks.