AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2018 Issue 3; Ask the Editor
Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction
A patient, who is post right mastectomy secondary to breast cancer, was admitted for prophylactic left mastectomy and bilateral deep inferior epigastric artery perforator (DIEP) flap reconstruction. At surgery, skin and subcutaneous tissue were removed from right and left abdominal incisions. The left hemi-abdominal tissue was placed on the left side after removal of the breast. The flap was secured to the chest wall and vessels anastomoses were performed. The right tissue expander was removed from the right mastectomy pocket, and the right hemi-abdominal flap was secured with anastomosis. Should the harvesting of the DIEP flap be coded separately? Additionally, in ICD-10-PCS is a mastectomy with breast replacement/reconstruction analogous to joint replacement surgery, in which the resection of the joint is not coded separately? ...
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Article Overview
This premium article discusses a breast reconstruction scenario involving DIEP flap reconstruction after mastectomy and focuses on how the procedure is viewed for coding purposes. It is intended for coders, billers, auditors, and clinical documentation professionals who work with surgical reconstruction and ICD-10-PCS/CPT reporting. The article examines whether parts of the operative work are reported separately and compares the reconstruction context with other procedure categories.
Why This Topic Matters
Breast reconstruction cases often involve multiple operative components, so accurate code reporting depends on understanding what is bundled versus separately reportable. This article helps readers evaluate how the documented surgical steps relate to coding structure in a reconstructive mastectomy setting.
What You Will Learn
- How a DIEP flap breast reconstruction case is framed for coding discussion
- Whether separate reporting is being questioned for parts of the operative work
- How the article compares breast reconstruction coding concepts with other procedure categories
- What general coding issue is raised by mastectomy with reconstruction in ICD-10-PCS
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Compliance professionals
- Clinical documentation specialists
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