september 2014

Flaps (Skin and/or Deep Tissue)

What’s the major difference between an adjacent tissue transfer and a pedicle flap?  With an adjacent tissue transfer the flap is developed immediately next to the defect and then rotated or advanced into that area.  A pedicle flap is developed from an area that is a short distance from the defect and once elevated the flap remains attached to a pedicle that maintains the blood supply into that flap to keep it viable.  Once the pedicle flap has been transferred into wound it is sutured into place.  At this point in time the pedicle can be divided releasing it from the area where it was harvested.  When that is the scenario then you would report a code from the 15570-15576 series “Formation of direct or tubed pedicle with or without transfer”.  This was done as a one stage procedure wherein the direct pedicle was formed and a transfer was accomplished.

In the second scenario, we have the same situation except that there is no transfer.  Again, you initially report the appropriate from code 15570-15576 - “Formation of direct or tubed pedicle with or without transfer” but in this case the physician opts to keep the pedicle attached until some degree of healing has occurred at which time the patient will return to have the pedicle divided and inset into defect.  The second procedure performed at a different date of service would be coded with the 15600-15630 series of codes “Delay of flap or sectioning of flap (division and inset)”

In the next subsection of the CPT Manual you will find the Category “Other Flaps and Grafts” with the first entry in this section being 15740 – Flap, island pedicle requiring identification and dissection of an anatomically named axial vessel.  In order to report this code the physician must first document the name of the vessel that will be dissected out and contained within the pedicle flap.  Once elevated the flap will be tunneled under the skin to the area where the defect is located.  The pedicle flap will be sutured into place and the donor site closed.  When it is necessary to perform closure of the donor site with a graft or an adjacent tissue transfer, those services may be separately reported.  


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