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?
Assign CPT code 13101, Repair, complex, trunk; 2.6 cm to 7.5 cm, with the additional centimeters reported with CPT code 13102, Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure), for the skin flap necrosis with debridement and flap reconstruction of the left breast. The repair was associated with the excision of the necrotic tissue and reconstruction of the existing flap. This code assignment is based on the CPT guidance that undermining of adjacent tissues to achieve closure without additional incisions is coded to a complex repair code. It is not appropriate to assign CPT code 19380, Revision of reconstructed breast, as the intent was not to revise the previously reconstructed breast.