AHA Coding Clinic® for HCPCS - 2019 Issue 3; For Your Information

Mastectomy skin necrosis

A patient with previous bilateral mastectomy, first stage reconstruction with tissue expanders and Alloderm presented with skin flap necrosis on the left breast where she originally had a Wise pattern skin-sparing mastectomy. The nonviable tissue was debrided and the Wise pattern was re-elevated over the underlying pectoralis major musculature and previous abdominal flap. The elevated Wise pattern was then advanced inferiorly and medially on the lateral and medial flaps. The total area of undermined tissue was at least 20 x 30 cm. Inset to the tissues was accomplished in layers to re-approximate deep dermis. How do you code an advancement flap reconstruction for skin flap necrosis? Is CPT code 19380 reported or a code from code range 14xxx to capture the adjacent tissue transfer or rearrangement? ...

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