Part 5: CPT Breast Education Series | Breast Reconstruction Using Autologous Tissue Flaps
There are two ways reconstruction with a tissue flap may be done: pedicle or free flap.
Pedicled flap – The flap remains attached at one end to its blood vessels and the rest of the flap is tunneled beneath the skin to the chest site.
Examples: TRAM (Transverse rectus abdominis muscle – abdomen); Latissimus dorsi (back)
Source:
https://commons.wikimedia.org
Free flap – The flap is completely detached from the body along with its blood vessels and reattached by microsurgery in the position of the reconstructed breast
Examples: TRAM (Transverse rectus abdominis muscle – abdomen); DIEP (Deep inferior epigastric perforator- abdomen); SIEA (Superficial inferior epigastric artery – abdomen); Gluteal (buttock)
Source: https://en.wikipedia.org/wiki/Breast_reconstruction
In CPT there are five different codes that may be assigned for a breast reconstruction using an autologous flap. Free flaps are all grouped under 19364, regardless of the specific type of flap.
19364
Breast reconstruction with free flap
Pedicled autologous flaps are specific for the type of flap – either TRAM or latissimus dorsi.
19361
Breast reconstruction with latissimus dorsi flap, without prosthetic implant
19367
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site;
19368
with microvascular anastomosis (supercharging)
19369
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor site
All the flap reconstruction codes include:
- Elevation and transfer of the flap
- Muscle dissection
- Closure of the donor site
- Breast contouring
Part 6 of this series will discuss revision of a reconstructed breast.
References:
CPT Assistant, August 2005, Volume 15, Issue 8, pages 1-3
CPT Assistant, October 2000, Volume 10, Issue 10, pages 1-3
https://www.youtube.com/watch?v=iqKTBB0Lgmg (DIEP free flap procedure)
https://www.youtube.com/watch?v=onqiPSSuLuw (Pedicled TRAM flap procedure)
The information contained in this series is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Coding Tip: New ICD-10 Codes for FY2023 and Proposed IPPS Rule
Wow, have you seen the proposed rule for FY2023 IPPS yet? There are 1,495 proposed coding changes to ICD-10-CM diagnoses codes alone! There are also some IPPS changes to note. As for ICD-10-PCS, there are not as many new codes, most significantly occlusion of prostate artery and knee joint replacement codes.
Coding Tip: Never-ending Denials
Coding denials are sent after the auditor has reviewed the record in question and the auditor does not agree with the DRG that was paid. This can be for either a diagnosis or a procedure code that they think does not meet reporting requirements.
Introducing HIA’s Cloud-Based Audit Software, Atom Audit, Streamlining Your Coding Auditor’s Workday and Transforming Data into Action
Our new coding audit platform is an easy-to-use and intuitive coding review application, with a customizable reporting dashboard, that enables auditors to efficiently and effectively manage the entire audit lifecycle.
Coding Tip: New ICD-10 Codes and IPPS Changes for April 1, 2022
As of April 1, 2022 discharges, the following changes in ICD-10 and IPPS will be implemented. For years the coding community did not see changes occurring in April of the fiscal year. HIM professionals were used to not even worrying about April changes. This year, we do have some significant code additions and a change in the IPPS CC/MCC edit. The ICD10MCE and Grouper Version will be 39.1.
Part 10: Most Common DRG’s with Recommendations – DRG 190
DRG 190 (Chronic obstructive pulmonary disease with MCC) was the number 10 most common DRG with recommendations from HIA in 2021.
Part 9: Most Common DRG’s with Recommendations – DRG 640
DRG 640 (Miscellaneous disorders of nutrition, metabolism, fluids, and electrolytes with MCC) was the number 9 most common DRG with recommendations from HIA in 2021.
Part 8: Most Common DRG’s with Recommendations – DRG 981/982
DRG 981 (Extensive O.R Procedures unrelated to principal diagnosis with MCC) was the number 8 most common DRG with recommendations from HIA in 2021.
Part 7: Most Common DRG’s with Recommendations – DRG 682
DRG 682 (Renal failure with MCC) was on of the most common DRG with recommendations. Renal failure can either be a chronic or acute condition.
Part 6: Most Common DRG’s with Recommendations – DRG 793/794
DRG 793 (Full term neonate with major problems and DRG 794 (Neonate with other significant problems) are reported together.
Part 5: Most Common DRG’s with Recommendations – DRG 193
DRG 193 (Simple pneumonia and pleurisy with MCC). DRG 193 seems to always be in the top 5 and a focus for denials.
Part 4: Most Common DRG’s with Recommendations – DRG 189
DRG 189 (Pulmonary edema and respiratory failure). This should be no surprise to coders that DRG 189 is in the top DRG’s with recommendation.
Part 3: Most Common DRG’s with Recommendations – DRG 291
DRG 291 (Heart failure with shock with MCC). This should be no surprise to coders that DRG 291 is in the top DRG’s with recommendation. It seems to always be in the top 5 and a focus for denials.
Part 2: Most Common DRG’s with Recommendations – DRG 177/178
DRG 177 (Respiratory infections and inflammations with MCC) and 178 (Respiratory infections and inflammations with CC). This should be no surprise to coders that DRG 177 is in the top DRG’s with recommendation.
Part 1: Most Common DRG’s with Recommendations – DRG 871
Sepsis is and will most likely always be a troubled area for coders. There are multiple reasons for this and we will look at a few of these. There are many different criteria being used to validate the diagnosis of sepsis.
Coding Tip: Common Errors Found in Anterior and Posterior Spinal Fusion Coding for Hospitals
During a recent review of spinal fusion cases at a client, we found coding issues on the cases in which both an anterior interbody fusion, anterior open approach was done on one day and two days later, the patient was brought back for a posterior fusion, posterior open approach. Below are some of the recommendations we made along with education explanations.
Part 5: New 2022 CPT Codes – Modifiers, Category III codes, Evaluation and Management, etc.
This is Part 5 of a five part series on the new 2022 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
Part 4: New 2022 CPT Codes – Nervous, Ocular and Auditory Systems
This is Part 4 of a 5 part series on the new 2022 CPT codes. In this one we will explore the nervous, ocular and auditory systems CPT changes.
Part 3: New 2022 CPT Codes – Digestive, Urinary and Reproductive Systems
This is Part 3 of a 5 part series on the new 2022 CPT codes. In this one we will explore the digestive, urinary and reproductive system CPT changes.
Part 2: New 2022 CPT Codes – Cardiovascular System
This is Part 2 of a five part series on the new 2022 CPT codes. In this series we include examples to help the coder understand the new codes.
Part 1: New 2022 CPT Codes – Integumentary, Musculoskeletal Systems
This is Part 1 of a five part series on the new 2022 CPT codes. In this series we include examples to help the coder understand the new codes.
Home Alone ICD-10 Codes
10 ICD-10 Codes from the Christmas movie Home Alone. T20. 10XA for Harry, Burn of first degree of head, face, and neck, unspecified site, initial encounter. T20.56XA for Kevin and his aftershave incident, Corrosion of first degree of forehead and cheek, initial encounter.
Coding Tip: New COVID Vaccine Codes
CMS released seven new procedure codes related to the introduction or infusion of therapeutics, including vaccines for COVID-19 treatments.
Coding Tip: New 2022 CPT Codes
There are a total of 249 new, 63 deleted and 93 revised CPT codes for 2022. That brings the total number of CPT codes to 10,819 per the AMA.
Coding Tip: FY2022 IPPS Final Rule and Unspecified Laterality Diagnosis Codes
Did you get a chance to read the FY2022 IPPS Final Rule? There is an interesting topic that was discussed regarding unspecified ICD-10-CM laterality diagnosis codes, to be exact. In this coding tip we discuss that subject and possible ramifications of it in the coding world.
Part 4: New 2022 Technology Add-On Payments (NTAP)
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Part 3: New 2022 IPPS Changes
This is Part 2 of a 4 part series on the FY2022 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented.
Coding Tip: AHA COVID FAQs for ICD-10-PCS & New Technology
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
Part 2: New 2022 ICD-10-PCS Procedure Code Changes
This is Part 2 of a 4 part series on the FY2022 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented.
Part 1: New 2022 ICD-10-CM Codes
This is Part 1 of a 4 part series on the FY2022 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis codes and changes.