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Free Nipple Grafts with Breast Reduction
In the setting of breast reduction, when free nipple grafts are done, is this separately reportable?
Question:
In the setting of breast reduction, when free nipple grafts are done, is this separately reportable?
Answer:
No – it would not be appropriate to report CPT 15200 for the harvest of the nipple areola complex for free graft. This work is considered included in CPT 19318 for breast reduction and therefore not separately reportable.
For the scenario as described, the appropriate CPT to report is only 19318.
*This response is based on the best information available as of 6/19/25.
Coding for Goldilocks
How do I code for a “Goldilocks” Reconstruction?
Question:
How do I code for a “Goldilocks” Reconstruction?
Answer:
KZA would like to thank you for this great question!
In the “Goldilocks” procedure, what remains of skin following a mastectomy is used to create a breast mound.
The ASPS advises using an adjacent tissue transfer code (ATT 14XXX), with the dimension based only on the inferior tissue that is separately incised and transferred to create the breast mound. They also describe this procedure as “similar to” an autoderm flap.
In a CPT Assistant from April 2021, there is an instruction to report the adjacent tissue transfer codes for reporting a de-epithelialized autoderm flap based only on the transposed area.
To assign the appropriate code for the Goldilocks procedure, the dimension based only on the inferior tissue that is separately incised and transferred should be documented clearly. The remaining skin closure is considered included.
*This response is based on the best information available as of 6/05/25.
13160 in Addition to Tendon Repair?
We have a patient who sustained a laceration that was repaired in an emergency room. The patient now presents to our plastic hand surgeon to repair a lacerated tendon. The previously closed wound is opened, and the tendon repair is performed. Would it be appropriate to report 13160 in addition to the tendon repair CPT?
Question:
We have a patient who sustained a laceration that was repaired in an emergency room. The patient now presents to our plastic hand surgeon to repair a lacerated tendon. The previously closed wound is opened, and the tendon repair is performed. Would it be appropriate to report 13160 in addition to the tendon repair CPT?
Answer:
No – an opening and closure are inherent in the tendon repair.
In this scenario, it would not be appropriate to report CPT 13160 in addition to the tendon repair – closure is inclusive.
*This response is based on the best information available as of 5/22/25.
Trigger Finger Release with Tenosynovectomy
In our practice, we often receive cases where the patient comes in for trigger finger release. Tenosynovitis is also identified after the procedure starts. In addition to performing the trigger finger release, a tenosynovectomy is performed on the involved tendon. Can we report both?
Question:
In our practice, we often receive cases where the patient comes in for trigger finger release. Tenosynovitis is also identified after the procedure starts. In addition to performing the trigger finger release, a tenosynovectomy is performed on the involved tendon. Can we report both?
Answer:
Thank you for your inquiry.
According to AAOS Global Service Data, tenolysis or tenosynovectomy is included in procedure code 26055, and any tenolysis or tenosynovectomy would not be separately reported. Additionally, there are NCCI edits between 26055 and 26440 /26442, respectively. The edit may not be bypassed with a modifier.
The intent of the surgery is to release the trigger finger, which would be appropriately reported with CPT 26055.
*This response is based on the best information available as of 5/8/25.
Arthrodesis With Local Graft
What is the appropriate CPT code to report when local autograft is used and taken from the reamings and allograft is used for arthrodesis of the IP joint? Which CPT code is correct, 26862 or 26860?
Question:
What is the appropriate CPT code to report when local autograft is used and taken from the reamings and allograft is used for arthrodesis of the IP joint? Which CPT code is correct, 26862 or 26860?
Answer:
Thank you for your question.
CPT 26860 includes using locally obtained autograft bone in addition to the allograft. In contrast, CPT code 26862 is reported when an autograft is obtained from a separate site and is valued for the additional work involved in obtaining that graft from a separate anatomical location.
Based on the question and presented scenario, the correct CPT code is 26860.
*This response is based on the best information available as of 4/24/25.
ICD-10 For Flap Failure
We have a reconstructed breast with a free flap, but the flap is no longer viable and requires removal. What would be the appropriate ICD-10 code for Flap Failure to assign for this encounter?
Question:
We have a reconstructed breast with a free flap, but the flap is no longer viable and requires removal. What would be the appropriate ICD-10 code for Flap Failure to assign for this encounter?
Answer:
Thank you for your inquiry.
There is no specific ICD-10 code for this. Reporting a complication code would be appropriate to describe the flap failure. Given the lack of specifics on the cause of the flap failure, some may look to assign an unspecified ICD-10 code. However, AHA directs to report ICD-10 T85.898A for flap failure.
T85.898A - Other specified complication of other internal prosthetic devices, implants and grafts, initial encounter
*This response is based on the best information available as of 4/10/25.
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