Muscle Flap Denial

Question:

We received a denial for a muscle flap. We appealed, and unfortunately, the denial was upheld due to the documentation. Can KZA provide some insight?

Answer:

Thank you for your inquiry.

The operative note was not included in this inquiry. Documentation should support flap elevation, identification, and preservation of the blood supply (naming the pedicle/ identifying the vein and artery), transfer and inset of the flap, and donor site closure.

Documenting the details is essential – these codes are being scrutinized more closely!

*This response is based on the best information available as of 7/03/25.