Coding for Adjacent Tissue Transfers

This month the “Spotlight on CPT” is shining on the topic of adjacent tissue transfers.  The procedure of adjacent tissue transfer (ATT) is also termed rearrangement and involves moving tissue to repair a defect.  There are a number of different methods that can be used for ATT including Z-plasty, W-plasty, V-Y -plasty, and various flaps (rotational, random island, or advancement).  Pictures of each of these repairs follow the body of this article. 

It is important to note that when repair of wounds accidentally results in one of the specific configurations noted above, for example a W-plasty, that does not qualify as W-plasty.  The surgeon must perform this specific procedure in order to assign the adjacent tissue transfer code.  Likewise, simple undermining that might be performed to facilitate closure is not considered ATT.

One of the most important and often overlooked pieces to remember when coding for ATT is that if an excision of a lesion is performed first, it is NOT separately reportable.  CPT Codes 14000-14302 include the excision of a lesion at the site.

Another consideration is that of the term “defect”.  The defect is both the primary and secondary defects with the primary being the area excised and the secondary being the area that results from the flap.  The measurement of both of these areas is used to determine which CPT code to assign. 

The ATT codes are categorized first by body part:

o   Trunk (14000-14001)

o   Scalp, arms, and/or legs (14020-14021)

o   Forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet (14040-14041)

o   Eyelids, nose, ears and/or lips (14060-14061)

Then, the codes are subdivided by size:

o   10 sq. cm. or less

o   10.1-30.0 sq. cm.

In the event that any ATT repair is 30.1-60.0 sq. cm. then code 14301 is assigned.  Should ATT go beyond 60.0 sq. cm. add-on code 14302 is assigned for each additional 30.0 sq. cm. or part thereof. 

Let’s look at an example: lesion removed from abdomen with ATT

The final piece to remember when coding for ATT is that if a skin graft is performed to close the secondary defect, then that is separately reportable.  Here is an example of an adjacent tissue transfer advancement flap of the scalp measuring 2 x 10 cm. with a split-thickness skin graft from the thigh for the secondary defect of 1 x 10 cm.  

Now, light has been shed on coding for adjacent tissue transfers.

Z-plasty

 

 

 

 

 

W-plasty

 

 

 

 

 

 

V-Y plasty

 

 

 

 

Rotation flap

 

 

 

 

 

 

 

 

Random island flap

 

 

 

 

 

 

 

Advancement flap

 

 

 

 

 

 

 

 

About the Author 

Dianna Foley, RHIA, CHPS, CCS, CDIP  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.