Forum - Questions & Answers

Aug 25th, 2022 - Fancy94 1 

Adjacent Tissue Transfer with 2 surgeons

If there are two surgeons with different specialties, in the same surgical session, on the same date of service for the same lesion, can one surgeon charge for the excision of the malignant lesion and the other surgeon charge for the adjacent tissue transfer? The CPT book clearly states "The excision of a benign lesion(11400-11446) or a malignant lesion (11600-11646) is not separately reportable with codes 14000-14302". This seems like unbundling and charging the patient for additional services that should be reported with one comprehensive code. Any advice would be very much appreciated!

Aug 25th, 2022 - ChrisW   256  1 

re: Adjacent Tissue Transfer with 2 surgeons

There are several things going on here that may be incorrect if reported this way. First, if the procedure includes the repair, you are correct; it is not separately reportable. You may want to reach out to your provider rep on the plan you are billing about two physicians, same lesion, same session. I am not finding anything that allows two physicians for these procedures. Unless there is extensive damage, the payer may make that determination. Check out these resources.      AMA guidelinesThe AMA guidelines state that codes 14000-14320 are used for excision (including lesion) and/or repair by adjacent tissue transfer or rearrangement. It will depend on the code selection; Check out the NCCI Policy Manual. The following information is from chapter III. “adjacent tissue transfer, and grafts may be separately reportable if medically reasonable and necessary”.NCCI edit policy chapter III: Lesion removal may require closure (simple, intermediate, or complex), adjacent tissue transfer, or grafts. If the lesion removal requires dressings, strip closure, or simple closure, these services are not separately reportable. Thus, CPT codes 12001-12021 (Simple repairs) are integral to the lesion removal codes. Intermediate or complex repairs, adjacent tissue transfer, and grafts may be separately reportable if medically reasonable and necessary. However, excision of benign lesions with excised diameter of 0.5 cm or less (CPT codes 11400, 11420, 11440) includes simple, intermediate, or complex repairs which shall not be reported separately. If more than one lesion is removed and one of those lesions is larger than 0.5 cm, an intermediate or complex repair may be reported, if performed for a lesion larger than 0.5 cm. Removal of one lesion smaller than 0.5 cm does not preclude also reporting an intermediate or complex repair for a larger lesion.NCCI EditsCheck the NCCI edits for the code pairs. The CPT Manual or CMS manual coding instructions state an NCCI edit exists with 14000 and 11400; the tissue transfer includes the removal or excision. Use the NCCI editor for other code pairs and view the rationale. If you use Find-A-Code the rationale is found in the results, and the Policy is at the top of the page. Medicare Fee Schedule IndicatorsLook at the Medicare fee schedule indicators for each code being reported, two surgeons are generally not allowed for this type of procedure, so this is not an option. For example, CPT code 14000 states an assist, co-surgeons, or team of surgeons is not allowed on this procedure, so you cannot bill the additional provider with a modifier 80, 82, 62, or 66. Exceptions:There are two exceptions stated in the NCCI policy, one being a staged or related procedure (modifier 58) which does not seem to fit here, and a Distinct Procedural Service (Modifier 59). These are the only two modifiers that may be reported to override the NCCI edits, and neither of these seems to apply.Another consideration is the procedure being done for cosmetic reasons; if so, this changes everything, and it may not be payable at all by a federal or commercial payer.  You are on the right track; I hope some of these suggestions help you. I would suggest referring to the NCCI policy manual with the specific codes you are inquiring about for additional direction.  

Aug 26th, 2022 - Fancy94 1 

re: Adjacent Tissue Transfer with 2 surgeons

Thank you very much for your quick and very informative response! I will use the tools you have suggested to explain this to the surgeons.

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association