Pharyngoplasty With Free Flap Reconstruction

Question:

I’m doing the repair of the oral cavity defect with a free flap reconstruction after the head and neck surgeon has resected the cancer. Can I code both 42950 and the free flap code such as 15758?

Answer:

The free flap codes include the harvest, inset, microvascular anastomosis, and closure of both donor and recipient site defects. You may separately code the harvest of graft material through a separate incision (e.g., split thickness skin graft) to facilitate the donor defect closure. So the answer is no, it is not accurate to separately code for a pharyngoplasty when you are insetting the free flap.

A CPT Assistant article from April 2016 addresses this situation in great detail.

Question:

Is code 42950, Pharyngoplasty (plastic or reconstructive operation on pharynx), reportable in addition to code 15757, Free skin flap with microvascular anastomosis, when a free flap is used to reconstruct both a neck and tongue defect (after laryngectomy or glossectomy)? The microvascular free flap is de-epithelialized and the skin paddle is used to complete the pharyngeal closure. The rest of the flap is used to complete the esophageal closure.

Answer:

No, CPT code 42950 should not be reported in addition to code 15757, when a free flap is used to reconstruct both a neck and tongue defect (after laryngectomy or glossectomy). The intraservice work of code 42950 is encompassed in code 15757, which includes harvesting a donor free flap, insetting the free flap at the recipient site using microsurgical technique, and closure of both donor and recipient sites. The pharyngeal reconstruction should be included in code 15757, as it would for wherever the flap was inserted. In addition, the inclusion of the flap closure should be considered as part of the work included in the basic closure of the primary resection site. This basic closure is inclusive of code 15757.

*This response is based on the best information available as of 12/15/16.