What is the CPT code for an advancement flap?
For example, if the surgeon performs a rotational flap for an area that is 7 x2 cm on the neck and then an advancement flap for an area that is 3 x4 cm on the foot, you would code 14041 x1 for the adjacent tissue transfer of 14 sq cm on the neck and then 14041 x1 again for the adjacent tissue transfer of 12 sq cm on the foot.
How do advancement flaps work?
This involves stretching the skin of the flap. Thus, advancement flaps work best in areas of greater skin elasticity. The most basic advancement flap is the simple linear layered closure, which involves undermining and direct advancement of tissue side to side to close the defect primarily.
When to convert a flap into a bilateral advancement flap?
If tension remains despite wide undermining, the surgeon may consider lengthening the flap or converting it into a bilateral advancement flap to obtain additional tissue movement. 11 If the surgical defect is secondary to Mohs micrographic surgery, it is likely that the wound edges are beveled.
What is the Y-V advancement flap?
The Y-V advancement flap has a similar principle to the V-Y flap except that the V-shaped flap is stretched or pulled toward a linear incision made at the apex of the triangular flap. The borders of this incision are allowed to spread apart, creating a tissue void. The flap is advanced into the void and sutured in place.
What is an advancement skin flap?
A single pedicle advancement skin flap is a flap that is mobilized by undermining and advancement into a defect without altering the plane of the pedicle. This technique can be considered for use in repair when there is skin available on only one side of a wound.
How do I bill for CPT code 15734?
Medicare guidelines do not allow use of modifier 50 (bilateral procedure) with 15734. Therefore, if both sides of the rectus sheath are mobilized, you would report one unit of 15734 plus a second unit of 15734 with modifier 59 appended (15734, 15734-59) and bill full fee for both procedures.
Is an advancement flap an adjacent tissue transfer?
Adjacent Tissue Transfer: A random pattern local flap which is used to fill in nearby or local defect. To be considered an Adjacent Tissue Transfer an incision must be made by the surgeon which results in a secondary defect. Examples include transposition flaps, advancement flaps and rotation flaps.
What is the CPT code for rotational flap closure?
Procedure performed for CPT code 14020 & 14021 Examples include; transposition flaps, advancement flaps and rotation flaps. The physician transfers or rearranges adjacent tissue to repair traumatic or surgical wounds of the scalp, arms, and/or legs.
What is CPT code for muscle flap?
CPT® 15734, Under Flaps (Skin and/or Deep Tissues) Procedures. The Current Procedural Terminology (CPT®) code 15734 as maintained by American Medical Association, is a medical procedural code under the range - Flaps (Skin and/or Deep Tissues) Procedures.
What is the CPT code for Fasciocutaneous flap?
Report 15732 for a muscle, myocutaneous, or fasciocutaneous flap obtained from the head and neck; 15734 if obtained from the trunk; 15736 if obtained from an upper extremity; and 15738 if obtained from a lower extremity.
What is advancement flap closure?
The primary goal of an advancement flap is to transfer the tension of the scar that would result from side-to-side closure to a more cosmetically acceptable site. Such sites include relaxed skin tension lines and the boundaries between cosmetic units (eg, melolabial fold, melolabial crease).
How do you bill for adjacent tissue transfer?
Adjacent tissue transfer or rearrangement procedures include excision (CPT codes 11400-11646) and repair (12001-13160). Thus, CPT codes 11400-11646 and 12001-13160 shall not be reported separately with CPT codes 14000-14350 for the same lesion or injury.
What is the difference between adjacent tissue transfer and flap?
Moderator, CCO Instructor. Tissue transfer is when they take tissue from someplace else and cover the wound. A flap is also taking tissue but from close to the woud and it is flopped over the wound.
What is a rotational skin flap?
Rotation flaps are local flaps that use adjacent tissue rotated in an arc to close a defect. They are nearly always random flaps composed of skin and subcutaneous tissue devoid of segmental vessels. They ultimately rely on perforators that course superficially to supply the dermal and subdermal plexuses.
What is procedure code 14301?
14301 - CPT® Code in category: Adjacent tissue transfer or rearrangement, any area.
What is procedure code 14020?
Adjacent tissue transfer or rearrangementCPT® Code 14020 in section: Adjacent tissue transfer or rearrangement, scalp, arms and/or legs.
How do advancement flaps work?
Most rotation flaps are also facilitated by advancement of their pivotal point. True advancement flaps have a linear configuration and are moved by sliding toward the defect. This involves stretching the skin of the flap. Thus, advancement flaps work best in areas of greater skin elasticity.
What is advancement flap?
The most basic advancement flap is the simple linear layered closure, which involves undermining and direct advancement of tissue side to side to close the defect primarily.
What is a subcutaneous tissue flap?
The subcutaneous tissue pedicle island advancement flap is a unipedicle advancement flap without a cutaneous component to the pedicle. The pedicle of the flap consists only of subcutaneous tissue, which is usually fat but on occasion may also incorporate muscle underlying the skin.
What is the problem with T-plasty flaps?
The greatest problem with T-plasty repair of large (2 cm or greater) circular cutaneous defects of the lip is ectropion of the vermilion as the wound heals. This is due to the contracture of the vertical portion of the T-shaped scar. In addition, T-plasty flaps are not pure advancement flaps. Some pivotal movement occurs, and this causes a small reduction in effective flap length. This in turn causes shortening of the vertical wound closure line. To avoid vermilion ectropion, a modified T-plasty can be performed. Instead of excision of the standing cutaneous deformity that develops opposite the incision lines for the two opposing flaps, the tissue of the deformity is preserved and used to lengthen the vertical component of the T-plasty scar (Fig. 9-7). The two opposing borders of the flaps are first approximated at the vermilion line. The resulting standing cutaneous deformity that forms opposite the flap incisions is marked. Only half of the typical incision to excise the deformity is made. This creates a flap of skin that is pivoted and advanced into a second horizontally oriented incision made in the opposing lip segment. The orientation and length of the second incision are designed after the first incision creating the flap of skin has been performed. The flap is positioned over the adjacent lip segment, and the distal end of the overlapping flap is marked on the lip segment. A line is drawn from this point to the lip segment wound border. The line is angled so it is centered beneath the linear axis of the overlapping flap. An incision is then made along this line. The borders of the incision are undermined. The flap is then sutured into the recipient site created by the second incision. On occasion, a small portion of the flap must be trimmed to allow it to fit perfectly within the opposing lip segment. This technique in essence is a modified Z-plasty, which has the effect of lengthening the otherwise straight vertical component of the T-plasty scar. The vertical scar resulting from the modified T-plasty has an irregular Z-shaped configuration (Fig. 9-8).
Why is undermining the advancement flap important?
Complete undermining of the advancement flap as well as of the skin and soft tissue around the pedicle is important to enhance tissue movement. In contrast to pivotal flaps, which form a single standing cutaneous deformity, two deformities are created with all unipedicle advancement flaps.
What is the most effective technique for forehead reconstruction?
The most effective technique for reconstruction of forehead cutaneous defects usually involves one or more advancement flaps. In spite of the relative inelasticity of forehead skin, the use of advancement flaps versus pivotal flaps is preferred because they typically produce the best aesthetic results. This is because incisions necessary for advancement flaps may be placed in the horizontal creases of the forehead or along the border of the eyebrow, depending on the location of the defect. Transposition flaps work well in the region of the temple, but more medially on the forehead it becomes difficult to close the donor site when such flaps are used.
What is a bipedicle flap?
Bipedicle advancement flaps are used primarily for repair of large defects of the scalp. The flap is designed adjacent to the defect and is advanced into the defect at a right angle to the linear axis of the flap. This leaves a secondary defect that usually must be repaired with a split-thickness skin graft. As a consequence, bipedicle flaps are rarely used for reconstruction of the face and neck. The exception to this is bipedicle nasal vestibular skin advancement flaps used for lining full-thickness nasal defects of the hemi-tip or ala that have a vertical height of no more than 1.0 cm (see discussion of this flap in Chapter 18). The flap consists of vestibular skin and mucosa based medially on the septum and laterally on the floor of the nasal vestibule. An extended intercartilaginous incision is made and the flap is elevated off the undersurface of the alar cartilage and mobilized inferiorly to line the ala or hemi-tip. The donor site on the ventral aspect of the cartilage is covered with a thin full-thickness skin graft. The bipedicle flap is thin and provides natural physiologic material for the interior of the nasal passage with sufficient vascularity to support the concomitant use of free cartilage grafts placed over the lining flap for structural support of the construction.
What is the advancement flap?
The prominent horizontal lines make the advancement flap particularly useful in the reconstruction of the eyebrow and forehead areas.
Can wound closures distort free margin?
Any form of wound closure has the potential to distort a free margin but advancement flaps, which are strictly linear, carry a significant risk if not oriented correctly. The surgeon can estimate the potential for asymmetry by pinching the defect closed in the direction of the flap’s movement.
Do H-plasties need to be parallel?
The incision lines do not need to be exactly parallel and may be curved to conform to RSTLs. The advantage of an H-plasty is that each flap must advance only half as far as the single flap design. It is used in situations where a unilateral flap will not provide adequate tissue for tension-free wound closure. 14.
Is advancement flap good for large defects?
The most important consideration is the amount of tissue laxity available for closure of the defect. An advancement flap does not lower the tension of closure much beyond that which can be achieved with a side-to-side closure and it is not a good choice for large defects without surrounding laxity. With experience, the surgeon can estimate ...
