CPT Coding Guidelines Review: Tissue Flaps and Grafts

This is a series of blogs about the importance of being familiar with CPT coding guidelines. Often there is extensive guidance preceding a subsection or range of codes for particular procedures, but coders are very busy so sometimes they jump right into the codes without taking time to review these guidelines, even though following or not following their direction could significantly affect the accuracy and comprehensiveness of coding.

This series is designed to help you become familiar with guidelines for significant procedures that you might not be acquainted with but do impact coding. The presentations are short and meant to generate awareness of the guidelines that are available in CPT rather than the application of guidelines to specific coding scenarios.

This installment of the series explores the guidelines related to CPT coding for tissue flap and graft procedures.

CPT Guidelines for Tissue Flap and Graft Procedures

Please watch this presentation to learn about the guidelines that provide direction in assigning CPT codes for tissue flaps and grafts.

Take Aways

• Tissue flaps have their own blood supply
• Attention should be paid to the region where the procedure is being performed and whether a procedure is intended to transfer a flap to its final site or to form a flap for later transfer
• Island pedicle flaps require incorporation of an anatomically named axial vessel
• Neurovascular pedicle flaps require incorporation of a sensory or functional motor nerve
• Code 15796 reports grafting of autologous soft tissue, unless there is a specific CPT code for the grafting of the specific tissue type or unless grafting is of autologous fat and meet certain criteria.

Test Your Knowledge

For detailed explanations of the quiz answers, please refer to the end of this blog post.

Additional Coding Education: Invest in You!

Be sure to watch for other installments of CPT Coding Guidelines Review and visit HIAlearn.com to explore other educational products designed to help coders be their best! Subscribe to our YouTube channel to be notified when the next video is live.

Quiz Answers and Rationale

Question 1: The answer is 15570. Formation of a tube for later transfer is assigned a code that references the donor site. In this case the donor site is the abdomen which falls under the anatomic region of trunk. Code 15570 reports formation of a tubed pedicle of the trunk without transfer.

Question 2: The answer is 15771, 15772. Code 15769 reports grafting of fat harvested by direct excision. Autologous fat grafting with cells harvested by liposuction is reported with codes 15771-15774. Code 15771 reports the first 50 cc of graft material. 15772 is assigned to report the additional 10 cc of graft material.

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The information contained in this coding advice 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.