Carotid Artery Exploration with Free Flap to Oral Cavity

Question:

Can we report 35701 for the carotid vessel exploration in the recipient site when doing a fibula free flap (20969)?

Answer:

No, this activity is included in the free flap code. CPT specifically states not to 35701 to explore and identify a recipient artery [eg, external carotid artery] when performed in conjunction with free flap codes including 15756, 15757, 15758 and 20969.

*This response is based on the best information available as of 07/23/20.

Complex Closure of Free Flap Donor Site

Question:

I did a right anterolateral thigh free flap and had to close the right thigh wound (4 x 8 cm) with undermining of additional 3 cm in either direction to close the wound without any significant tension. Can I also code a complex repair (13100, +13101) with the free flap code?

Answer:

Bringing the wound edges directly is included in the free flap code. However, CPT says that repair of donor site requiring skin graft or local flaps (e.g., adjacent tissue transfer requiring a separate skin incision to create a secondary defect) may be separately reported. Additionally, Medicare has a National Correct Coding Initiate (NCCI) edit between the free flap codes and the complex repair codes which could not be overridden because the procedures are in the same area. So, no, a complex repair code would not be used for closure of the flap donor site.

*This response is based on the best information available as of 07/09/20.

Excision External Ear

Question:

I did a partial excision of the left ear wedge with a layered closure. Can I code 69110 and a complex repair code since 69110 says “simple repair”?

Answer:

CPT 69110 includes the direct closure (bringing wound edges together) because it says “simple repair” so that would include a simple, intermediate or complex repair code. We would not recommend a separate repair code in the circumstance you describe.

*This response is based on the best information available as of 06/25/20.

Seroma after Breast Reconstruction

Question:

During the post-operative global period following breast reconstruction the patient presents with a seroma. Can I bill for the seroma excision and also bill for an office visit since it is a new problem?

Answer:

Medicare says treating the patient for issues related to the procedure, such as a seroma, are not separately payable unless they require a return to the operating room (modifier 78). There is not a modifier for “return to the office to treat a surgical complication.”

Check your other payors for their rules – in the absence of a specific payor rule allowing payment for treating complications in the office, we typically recommend you not bill. And, don’t forget, if you bill then the patient will have a co-pay.

*This response is based on the best information available as of 06/11/20.

Laceration and Fracture Repair

Question:

My physician is utilizing an open laceration on the patient’s chin for open reduction of a mandibular symphysis fracture and he wants to also charge for a complex laceration repair for that laceration. Is this billable or is it part of the ORIF code?

Answer:

If the fracture is repaired through the laceration then we code only the fracture repair – the laceration repair would not be separately reported.

*This response is based on the best information available as of 01/23/20.

Unspecified vs. Uncertain Behavior Skin Lesion Diagnosis Code

Question:

Can you refresh my memory on when to use the diagnosis code for skin lesion “uncertain behavior” vs “uncertain behavior”?  I know one is to be used before we get pathology results and one is for after, I just don’t remember which is which.  If you could give me the ICD10 codes that would be great too.

Answer:

You’ll use an “unspecified” diagnosis code when you do not have a final path report – D49.2 is for unspecified behavior lesion of the skin. Use the “uncertain” behavior diagnosis code when histologic confirmation whether the neoplasm is malignant or benign cannot be made by the pathologist.  Look up the path report diagnosis in the ICD-10-CM Index to if you have a path report.  Use D48.5 is for uncertain behavior of the skin.

*This response is based on the best information available as of 01/09/20.