Lesion-Excision Medical Coding: Adjacent Tissue Transfers


 

As you must know, if the defect is too big, sometimes the adjacent tissue transfers will be used to close them up a lot. A lot of times you will see them on forehead removals and things like that or in larger areas. Go through this expert coding and compliance article for more information.

What they are doing is they are releasing the adjacent tissue, cutting it off of the site but leaving a blood supply attached. This isn't like free graft or anything. So, they pull them up and then they kind of pull it over or they transfer the tissue over to the other area.

So, it's adjacent tissue. It's close to the defect or surrounding the defect and they just transfer it over so adjacent tissue transfer.  The big thing to remember with the ATT is that you add both the primary and the secondary defect and that these are in square centimeter. So, you will have the physician using terms like Z-plasty or, you know, they may say it with a rhomboid flap, those kinds of things that you will be coding the ATTs for.

So, just remember that it is both the primary and the second defect and it is in square centimeters. And then also that when you're doing excision of a lesion and then an ATT, the excision of the lesion now bundles into the ATT code. So, always in a 10000 section to make sure you're looking at the guidelines for bundling issues. We have a lot of bundling issues in the 10000 CPT medical coding section.

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Also, don't forget you may have additional coding with the ATTs though for the secondary defect. AS per the medical coding guidelines, if you have to do a skin graft to close that secondary defect that you like to swung it down and over but now there's a big, old, you know, gaping wound left from where you did the ATT at the top from the donor site and you have to put a little skin graft on that, then you can code the skin graft as a second code, as a supplemental code, that it is in addition to the ATT. They do not bundle the graft that are necessary to close those defects.

But you do add the two together, the primary and the secondary, to get it. So if you have a one square centimeter defect and a two square centimeter donor site, then you would code a three square centimeter ATT. If the doctor doesn't give it to you in square centimeters, just multiply it up. So, if it's a 2x2, then it's four square centimeter. You know, if it's a 3x4 cm, then it's 12 square centimeters. So that part of it shouldn't be too hard as long as they're giving you the sizes.

When you go over the 30 square centimeter, which would be the 14300 and that is for an ATT more than 30 square centimeters, unusual or complicated. There, it's any area. So at that point, once it goes over 30 square centimeters, that's just big. And so, they just have one code for that in that area.

If that's how they learned to dictate it or that's how they document it now, you could also break it out that way so that they could give both pieces of information if that's how they like to notate them. So make the templates match what they do so that you get the information back that you need for coding but you want to make it easy for the provider.

To put the excisions of the lesions is not separately reportable, that the same lesion. Now, if you do an excision of a separate lesion like let's say the right arm and an ATT with an excision on the left arm, then of course, you're going to have an excision code but you would need to use your modifier -59 to show it with a separate lesion, that you weren't trying to unbundle following the medical coding rules.

So that again is one part of your medical coding where your modifiers become a big part of it so you don't lose money for an excision that was separately performed but there's no way to show it other than the modifier to say, “Hey, this was separate. I need to be paid for it.” So don't forget about your modifiers.

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