Coding Strategy

Discover why coding a myofascial flap twice is a big mistake.

Question: Our surgeon performs an abdominal closure using left and right myofascial advancement flaps. I believe we should code one unit of 15734 because flap codes refer to the recipient area — not donor site. But the surgeon believes we should code 15734 x 2 because he uses two flaps to perform the defect closure. What is the correct coding?

Arkansas Subscriber

Answer: You should not report 15734 (Muscle, myocutaneous, or fasciocutaneous flap; trunk) for this service — either once or twice. Instead, you should list the procedure using an adjacent tissue transfer code such as 14000 (Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less) or 14001 (… defect 10.1 sq cm to 30.0 sq cm) depending on the defect size.

Here’s why: Adjacent tissue transfer rearrangement includes repair by advancement flaps, according to CPT instruction in the introduction to those codes. On the other hand, 15734 does not specifically include myofascial flaps and does not describe advancement flaps for closure.

Size matters: Rather than coding this twice, you should code the entire size of the primary and secondary defects (including secondary defects for both flaps). If the defect is larger than 30.0 cm, you can still use the adjacent tissue transfer or rearrangement codes by listing 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm) and adding +14302 (… each additional 30.0 sq cm, or part therof [list separately in addition to code for primary procedure]) as needed.

@ General Surgery Coding Alert

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Relying on the physician’s encounter form could be a big mistake.

Question: I used 491.9 to report a patient’s bronchitis, but the payer denied my claim and requested additional information. What was wrong?

Vermont Subscriber

Answer: Your claim may have been denied because you chose an unspecified chronic bronchitis code (491.9, Unspecified chronic bronchitis) instead of a more specific ICD-9 code.

Here’s how to avoid “diagnosis coding” denials next time: Don’t rely on the physician’s encounter form, which usually lists nonspecific diagnoses to maximize space. Your physician’s documentation may actually be more specific.

For instance, your physician has recorded that treatment for an “acute exacerbation” of chronic bronchitis was provided. The term “acute” under 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) appears in the diagnosis definition. Therefore, if the physician sees a patient with an exacerbation of chronic bronchitis, you may report 491.21.

Snag: You may find your doctor unaware that proper documentation is critical. You should suggest that the pulmonologist be more specific on the terms and descriptions used in the chart when appropriate, and that, without proper documentation, unspecified codes may delay and/or reduce payment.

Smart: ICD-10-CM will prompt you for more specified coding. It’s important to incorporate specificity into your coding and documentation — as early as now.

@ Pulmonology Coding Alert

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