For ex., full thickness graft from thigh (donor)to repair defect on face (recipient).
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Tag Archives: graft
graft and complex repair on same site
If an excision is closed by performing complex repair on part of the wound and a graft on the other part, can you bill for the complex repair and the graft. The coding specialist at the AAD says no, but the medical direct at Modernizing Medicine says yes. Who’s right?
Allogenic Bone Graft CPT needed
I need some help, my doctor is asking for me to add a code for the bone graft on this arthrodesis, and my question is, is there a allogenic bone graft code for this? I looked at 20900 but it sounds like it is for a autograft harvesting which wasn’t done. I already have the bone marrow code so that part is covered but can’t figure out what code to add or if this would be inclusive of the arthrodesis. I’m still pretty new to Podiatry so could really use your advise.
Here is what I coded so far:
28750-LT Dx- M20.22, M96.0, M05.9 Arthrodesis,*great toe;*metatarsophalangeal*joint
20680-LT Dx- T84.84XA, T84.213A Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
38232 Dx- M20.22, M96.0, M05.9, T84.84XA, T84.213A Bone marrow*harvesting for*transplantation;*autologous 1
Operation findings when his follow; patient was brought into the operating room and after
sedation intubation on the gurney the patient then was placed on operating table in normal
supine position. left thigh tourniquet was placed which was well-padded the left lower extremity
then was prepped and draped in normal sterile fashion.
Attention was made to the anterior medial proximal tibia where a 1 em incision was made this
incision was deepened with blunt dissection down to the anterior medial cortex of the proximal
tibia before we entered the lightning bone marrow aspiration needle under power intramedullary.
We aspirated 60 cc of bone marrow aspirate concentrate this was handed off to the back table
where it would be center fused to 5 cc concentration. This wound then was irrigated closed with
a 4-0 nylon Xeroform 2 x 2 and a Tegaderm
left lower extremity then was exsanguinated and elevated tourniquet was inflated to 275 mmHg
pressure. Attention was made to the dorsal medial aspect of left first metatarsal phalangeal joint
where there is noted to be prior surgery this old incision was used as our new incision just medial
to the extensor hallucis longus tendon. This incision was straight down to bone with significant
amount of scar tissue all soft tissue reflected off of the first metatarsal head and the base of the
proximal phalanx. There was noted to be a proud screw backing out in the plantar medial aspect
of the first metatarsal head 3 oh headless compression screw that was tenting the skin all soft
tissues were released off of this and this was pulled out in toto will be sent to pathology. There
was a dorsal plate 4 hole that was broken right at the joint 2 screws proximal to screws distally
these were removed along with the broken plate and will be sent the pathology. There was no
signs of any infection or corrosion of any of the implants. There is noted to be nonunion fibrous
of the first MPJ. This time the joint then was prepared for revision arthrodesis by removing any
scar tissue fibrosis within the joint subchondral drilling of the subchondral plate of the first
metatarsal head and the base the proximal phalanx wound was copiously irrigated we then took a
5 mm first metatarsal head wedge allogenic graft from Paragon soaked in bone marrow for over
3 minutes and then put that in our joint for a distraction arthrodesis with good anatomical fit At
this time the first MPJ was placed in a proximally 5 degrees of dorsiflexion and about 5 degrees of
abduction we held this with 2 crossing wires we then using good AO techniques placed a large
first metatarsal phalangeal joint plate from Paragon using 6 3.5 fully threaded screws that were
locking we reviewed this multiple times intraoperatively under fluoroscopy using AP and lateral
making sure R’s platelet was well adhered to the bone with good alignment in all of our screws
were a good length. Once our plate and screws were satisfactory along with our alignment we
removed all temporary wires we then made the bone graft with demineralized bone matrix
approximately 2 cc and bone marrow aspiration 3 cc mixed with 1 cc of amnion right at our
arthrodesis site. Following this we then closed the wound using 3-0 Vicryl for the deep capsule
was then injected the other 2 cc of bone marrow aspiration concentrate and underneath the
capsule and then closed the skin with a 3-0 nylon postoperative injections included 10 cc of half
percent Marcaine plain. This is followed by overnight ointment Adaptic 4 x 4 fluffs Kerlix and an
Ace bandage. Tourniquet was dropped there is good perfusion all digits hemostasis was
controlled.
Bone Marrow aspiration w/Bone graft other than spine
I am seeking guidance on which would be the correct code to use for Bone Marrow aspiration w/Bone graft other than spine. There seems to be a contradiction in the guidelines/instructions regarding 20939 and 38232. Others have stated that 20999 should be used. Has anyone had any experience with these codes. Thank you
Complex repair plus graft on same site
If a wound requires a complex repair for one piece of it, plus a graft for the remaining little piece that couldn’t be closed with the complex repair, can you bill both?
need help with vein graft balloon angio only
PROCEDURES
1. Coronary angiogram
2. Left heart catheterization
3. Graft angiogram
4. Percutaneous intervention and balloon angioplasty of vein graft to OM1.
5. Right iliofemoral angiogram
1. Coronary angiogram
2. Left heart catheterization
3. Graft angiogram
4. Percutaneous intervention and balloon angioplasty of vein graft to OM1.
5. Right iliofemoral angiogram
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Right groin was draped and prepped in a sterile fashion. Patient was premedicated with 1.5 mg Versed and 100 mcg fentanyl IV. After injecting 2% lidocaine, right common femoral artery was accessed with the help of micropuncture with some difficulty due to previous scarring and 6 French femoral sheath was inserted. 6 French diagnostic catheters were used to cannulate left and right coronary artery. 6 French FR 4 catheter was also used to cannulate the vein grafts. Patient was proceeded with intervention of the vein graft of obtuse marginal branch. Overall patient tolerated procedure well. Right iliofemoral angiogram was performed and femoral sheath was pulled and manual pressure was applied for 20 minutes with good hemostasis. FemoStop was applied at Bell pressure for persistent hemostasis.
*
LEFT HEART CATHETERIZATION
Left ventricular end diastole pressure was 18 mmHg. No significant gradient across aortic valve.
CORONARY ANGIOGRAM
1. Left main was calcified with 70-80% distal stenosis.
2. Left anterior descending artery had severe diffuse disease proximally before it was 100% occluded for previous stents
3. Left circumflex artery was 100% occluded proximally
4. Right coronary artery was under percent occluded at the origin.
*
GRAFT ANGIOGRAM
1. Vein graft to LAD was under percent occluded (chronic)
2. Vein graft to RCA was patent. Stent was noted in the mid body of the graft which was patent with 80% in-stent restenosis. 50-60% stenosis noted in distal RCA after anastomosis before the bifurcation of PDA and PLV branches. PDA branch was patent with no significant disease given collaterals to distal LAD. PLV branch was patent.
3. Vein graft to obtuse marginal branch was patent with TIMI II antegrade flow. Stent at the ostium had 99% in-stent restenosis. There was also 80-90% stenosis of mid part of the body of the graft within the previous stent. Distal part of the vein graft was patent.
*
PERCUTANEOUS INTERVENTION OF VEIN GRAFT OBTUSE MARGINAL BRANCH
6 French JR4 guide catheter was used to cannulate the vein graft to OM 1. Heparin was used for anticoagulation. Initially filter wire was attempted for distal protection which was unsuccessful to advance due to significant ostial stenosis. 0.014 BMW guidewire was advanced and vein graft to OM stenosis was successfully crossed without difficulty. 2.5 x 15 mm noncompliant balloon was advanced and both lesions of vein graft was predilated at 16 followed by 18 atm. Nitroglycerin intracoronary was given. Subsequent angiogram revealed TIMI-3 antegrade flow and distal part of the body of the graft but still residual significant stenosis at the ostium. 3.5 x 15 mm noncompliant balloon was advanced and both lesions of vein graft were dilated at 16 atm couple of times. Adenosine followed by nitroglycerin were given through guide catheter. Subsequent angiogram revealed wide-open vein graft to OM with TIMI-3 antegrade flow and no evidence of dissection or perforation. No evidence of distal embolization. Patient was hemodynamically stable and asymptomatic at the end of procedure.
RIGHT ILIOFEMORAL ANGIOGRAM
Right common femoral artery was patent. Sheath insertion was just below the origin of the inferior epigastric artery..
IMPRESSION
1. Severe native 3 vessels coronary artery disease.
2. Patent vein graft to OM1 with 99% ostial stenosis within the stent as well as 80% instent restenosis within the mid body of the graft. (Likely culprit)
3. Patent vein graft to RCA with 80% in-stent restenosis.
RECOMMENDATIONS
Patient has complex coronary disease as described above. He had multiple intervention of vein graft in the past including 3 intervention in vein graft to OM last year. He has significant instent restenosis of drug-eluting stents. Recommend evaluation by cardiac surgery for possible redo CABG. Continue aggressive medical treatment.
*
should I do 93459,92937 -lc since this is vein graft balloon angio or 92920? I bill for hospital
thanks in advance
Split thickness graft chest/muscle flap- need advice :)
Hello, would you code the below as 15100,15734? Thank you
Procedure:
Pectoralis muscle flap
SPLIT THICKNESS SKIN GRAFT CHEST
VAC PLACEMENT
*
left lateral thigh will be used as a donor site in a similar area to her prior graft harvest. then brought back to the operating room and placed supine on the operating room table. SCDs were placed on bilateral lower extremities. arms were outstretched on padded foam arm rests and abducted to less than 90 degrees at the shoulder. underwent general anesthesia. prepped and draped in the usual sterile fashion. Prior to beginning of the procedure wound measurements were taken after the VAC was removed. left chest wall defect measured 6 x 5 x 1.5 cm. There was exposed pectoralis major, pectoralis minor, and ribs with a thin layer of periosteum. The wound bed was clean and started to granulate. An additional 1 cm margin was taken medially of subcutaneous tissue and pectoralis muscle. This was oriented with a single suture anteriorly and a double suture at 12:00 and sent to pathology. Upon inspection of the defect given the fact that the middle third of the pectoralis major muscle had already been taken during the prior resection it seemed appropriate to mobilize the superior third of the muscle and rotate it 90 degrees counterclockwise to fill the vertical defect underlying her open wound. Therefore using cautery the pectoralis major muscle fibers were removed from the sternal attachments as well as the clavicle. The deep side of the muscle was released off of what remained of pectoralis minor as well as the anterior border of the ribs. Care was taken not to damage the pectoralis major pedicle. Dissection proceeded until there was enough rotation in the muscle to allow the medial border of pectoralis major to cover the full extent of the defect. The entire wound bed was then copiously irrigated with 3 L of pulse lavage saline. Metal clips were placed to mark the superior and inferior medial lateral and deep borders of the recurrent tumor bed. Hemostasis was then achieved using electrocautery. The pectoralis muscle was then rotated into position and secured using 3-0 Vicryl sutures. There was not significant tension on the flap. The skin edges were tacked down to the muscle flap circumferentially in a similar fashion. At this point the skin defect requiring grafting measured 5 x 6.5 cm. A 1/14 inch split-thickness skin graft was harvested from the left lateral thigh using a 2 inch dermatome blade. It was meshed at a 1-1.5 ratio and secured to the pectoralis muscle using a running 5-0 chromic suture. Xeroform and a black foam sponge was placed over the graft. The VAC sponge was bridged to the left lateral chest wall and the system was secured at 125 mm of pressure. The left thigh was dressed with Xeroform, Tegaderm and Ace wrap. Anesthesia then performed a serratus block using Exparel
Placement of subgaleal siliastic spacer graft
Hi folks,
Does anyone know what code I should use to report the placement of subgaleal siliastic sheet "spacer graft"? Does it bundles into the flap?
Provider documentation summary:
PROCEDURES:
Delayed paramedian forehead flap measuring 3.2 cm x 7 cm.
Split-thickness skin graft
** flap was elevated in the subgaleal plane
** skin graft was trimmed to size and secured to the distal flap
** silastic sheet was placed below the graft on the forehead, is a spacer graft.
** silastic sheet was then trimmed to size, placed in the forehead wound bed and the flap was laid back down and secured
I am thinking 15731 for the paramedian flap, 15120 for the skin graft but not sure about the siliastic placement
Thanks in advance…
Facelift Graft
Does anyone know the CPT for a 4X8X8 mm Facelift graft. used during a Cervical fusion, of Odontoid Fracture?
Dbx bone graft
When a cpt code, for example 21147 lefort 1, 3pc, states with bone graft, does dbx or dbm (demineralized bone matrix) constitute with bone graft. I bill for the professional/surgeon in this scenerio. I think that the dbx/dbm is a product that the facility will bill for (hcpcs) but does not constitute application/harvesting of bone graft. I have looked for information regarding this and haven’t found anything concrete. Any thoughts, thanks!!!!