Coding a Composite Graft with Harvested Cartilage

Question:

I performed a composite graft (CPT 15760), and harvested cartilage from the ear.  Can I report for the harvesting?  If yes, what code do I use?

Answer:

You can report both 15760 (Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area) and CPT 15040 (Harvest of skin for tissue cultured skin autograft, 100 sq cm or less) for harvesting the graft.  These two codes are not bundled under the National Correct Coding Initiative and can be reported together.

*This response is based on the best information available as of 06/14/18.

Removal of Mandibular Implant

Question:

We are removing old plates from the right and left mandible. It is ok to use 20680 x 2?

Answer:

There was just a CPT Assistant about this in January 2018. CPT 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)) may be reported twice for removal of implants from noncontiguous sites on the same bone, such as the mandible, if separate incisions are made.  However, use 20680 only once if one incision is made to remove bilateral implants from the same bone such as the maxilla.

*This response is based on the best information available as of 04/19/18.

Fat Grafting with a Breast Revision

Question:

My doctor reports a breast revision with CPT codes 19380 and 20926 on the same breast.  Can we report the fat graft harvest in addition to the revision?

Answer:

CPT code 19380, Revision of reconstructed breast involves revising an already reconstructed breast. The code includes repositioning the breast; making adjustments to the inframammary crease; making capsular adjustments; and performing scar revisions, fat grafting, liposuction, and so on. Therefore, it is not appropriate to report the fat graft harvest with CPT 20926 as it is included in the procedure.

*This response is based on the best information available as of 03/15/18.

Removal of Tissue Expander in the Office

Question:

I have a question on tissue expander coding. How would I code for an in office procedure on a tissue expander removal under local anesthesia? The patient had breast cancer and the mastectomy was performed at a different facility. The patient’s tissue expander became exposed so the expander was removed at my facility in the office. I was trying to find some coding guidelines on this scenario. Any help you can give me would be greatly appreciated!

Answer:

The CPT code for removing a tissue expander in the office is the same as it is if the TE was removed in the hospital – the physician reports 11971 (Removal of tissue expander(s) without insertion of prosthesis). Medicare’s payment for the physician in the office (place of service 11) is somewhat higher than the payment in the OR (place of service 24, 22, 21).

*This response is based on the best information available as of 01/18/18.

Complex Closure with a Soft Tissue Tumor Code

Question:

Can I also bill for the complex repair when I’ve also excised a soft tissue tumor like a lipoma in the 21552-21555 series of codes?

Answer:

Actually CPT says these soft tissue tumor codes include the simple or intermediate repair and a complex repair may be separately reported.  That said, Medicare and many other payors will not reimburse the code because they consider it to be a primary closure.

*This response is based on the best information available as of 11/30/17.

Debridement Prior to Skin Grafting

Question:

I’m taking a patient to the OR for debridement of a dehiscent surgical wound and will skin graft it for closure. I’m looking at getting 11042 (debridement) and the skin graft codes precertified. Is this right?

Answer:

Not exactly.  You’re right about the skin graft code(s).  However, we do not recommend the 11042 – 11047 codes.  These codes are used for wound debridement but only when you are debriding an open wound with no intention of closing it; you expect the wound to heal by secondary intention.  In your example, you will be closing the wound.  Therefore, the more accurate code is a surgical preparation code (15002 – 15005) forexcision(note the term is not debridement) of the open wound to prepare a viable wound surface for grafting.

*This response is based on the best information available as of 11/16/17.