15734- muscle flap

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Joined: Thu Dec 14, 2017 9:08 am

Tue May 22, 2018 3:30 pm

In thoracic surgery when esophagectomies are done an intercostal muscle flap is done for coverage of a friable esophagus. There seems to be two schools of thought on how this should be billed correctly and I would like to have some feedback from my colleagues. Do you bill with a 22 modifier, an unlisted code or 15734? It seems some carriers allow the use of 15734 for surgeries and will not accept an unlisted code.

I would like some guidance on guidelines and how others are accepting this billing.
Posts: 11
Joined: Fri Apr 13, 2018 11:54 am

Tue May 22, 2018 4:33 pm

Hi Debben,

I am not a Thoracic Surgery coder and/or auditor, so forgive me if I do not understand the surgery accurately.

Here are my thoughts (without looking at the sugery note):

If we are covering the internal structures of the body,i.e, esophagus, with a muscle flap, I would not use the CPT code 15734. Because these codes are found in the Ingegumentary System of the CPT code book, I would argue they only represent covering the skin or layers of the skin such as for Breast reconstruction surgery. I do not think this CPT code implies we can use this code for "internal organs."

I would agree that you would use an unlisted code. If no code exist that most accurately reflect the procedure, then the unlisted code would be most appropriate.

I hope this helps.
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Seattle Children's Hospital
Seattle, WA
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Thu Jun 14, 2018 10:21 am

Muscle, myocutaneous, or fasciocutaneous flap; trunk

Lay Description

The physician repairs a defect area using a muscle, muscle and skin, or a fasciocutaneous flap. The physician rotates the prepared flap from the donor area to the site needing repair, suturing the flap in place. The donor area is closed primarily with sutures. If a skin graft or flap is used to repair the donor site, it is considered an additional procedure and is reported separately. Report 15732 for a muscle, myocutaneous, or fasciocutaneous flap obtained from the head and neck; 15734 if obtained from the trunk; 15736 if obtained from an upper extremity; and 15738 if obtained from a lower extremity.

Based on the question, I would not use the unlisted code with the modifier 22.

Your question has been answered by: Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CPC
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