Results 1 to 3 of 3

Removal of TRAM flap

  1. #1
    Default Removal of TRAM flap
    Medical Coding Books
    If the patient had a simple mastectomy with TRAM flap reconstruction and returns to the OR for recurrent breast cancer involving the TRAM flap how would you code this?
    OP Report reads: Flaps were raised at the clavicle, parasternum and latissimus dorsi. In order to get the breast off I had to get in the subpectoral plane, raise the breast off the muscle with Bovie cautery. Once the breast was lateralized a complete three-level axillary lymphadenetomy was carrid out skeletonizing the axillary vein, thoracodorsal neurovascular bundle and the long thoracic nerve. The nerves were proserved, I also used a Harmonic scalpel to track up along the axillary vien inferiorly up to where it penetrated the thoracic fascia. Those nodes were submitted as the highest level III nodes. The wound was closed in a T-fashion in order to get it closed. Patient taken to recovery room in excellent condition having tolerated the procedure well.

    CPT 21558 and CPT 38745 is what I found.
    Any suggestions would be helpful.

  2. #2
    This one made me think!!! My first question was, "where, exactly, is the recurring cancer?" It would be important to determine whether it has occurred in the flap or the remaining muscle, etc. I found this excerpt from coding guidance provided by AHIMA:

    "Some breast cancer patients have tumor recurrence after their mastectomy and it's especially important that the coder determine the exact site of the neoplasm. If no breast tissue remains, the tumor may actually involve the chest wall and should be coded accordingly. The physician may document "breast carcinoma" or "breast metastasis," but he or she may be referring to the cell type, not to the site of the neoplasm. Excisions of chest wall tumors are reported with CPT codes 19260, which includes rib excision, 19271, which includes plastic reconstruction but no mediastinal lymphadenectomy, and 19272, which includes plastic reconstruction and mediastinal lymphadenectomy."

    I'm not sure if this helps or not but referencing the pathology report would also be helpful in gaining an understanding as to where the malignancy actually was found. Good luck!


  3. #3
    Default bwray
    Thank you for responding, I've looked at the chest wall tumor excisional procedures but the surgeon doesn't remove a rib and doesn't do any plastic reconstruction (another surgeon does this)
    As far as the path report: Left Breast Biopsy of a Lesion consistent with recurrent carcinoma (ductal carcinoma with lobular features) reason to remove TRAM FLAP.The path report for the surgery I posted: Left Breast Tram Site Excision, no residual tumor identified including negative margins. So the Biopsy removed all of the tumor.
    I'd like to have a new CPT code added to cover this type of surgery without a rib resection.

    B Wray, CPC. CGSC

Similar Threads

  1. Right TRAM flap breast reconstruction
    By tmr1965 in forum Plastic Surgery
    Replies: 0
    Last Post: 10-06-2015, 06:16 AM
  2. fat necrosis following TRAM flap breast reconstruction
    By wdorian in forum Plastic Surgery
    Replies: 0
    Last Post: 06-12-2014, 08:21 AM
  3. Excision of TRAM Flap CPT?
    By AimeeNK31 in forum General Surgery
    Replies: 0
    Last Post: 06-17-2013, 07:39 AM
  4. Delay of TRAM flap
    By cjobson in forum Plastic Surgery
    Replies: 2
    Last Post: 03-10-2011, 07:15 AM
  5. Delayed TRAM flap
    By drreimers5 in forum Plastic Surgery
    Replies: 0
    Last Post: 09-20-2010, 01:32 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.