Coding Guidelines for Reconstructive Surgery CPT Codes

1. Visit our website: Click here Follow us: Coding Guidelines for Reconstructive Surgery CPT Codes Reconstructive surgery is a specialized field that involves the restoration of the body's form and function following injury, disease, or congenital abnormalities. Accurate selection of reconstructive surgery CPT codes is essential to ensure proper reimbursement and compliance with coding regulations. Note that CPT is the copyright of the American Medical Association (AMA), so sharing the complete list of reconstructive surgery CPT codes is not possible. For basic understanding, we shared some of the most commonly used CPT codes for reconstructive surgery and their coding guidelines. Most Common Reconstructive Surgery CPT Codes CPT Codes 14000 – 14302 CPT code range 14000 - 14302 is used for skin substitute procedures, including grafts and flaps, used to restore skin tissue loss due to injury or disease. Following are some guidelines on how to use these reconstructive surgery CPT codes: Determine the type of skin substitute procedure being performed: The codes in this range include various types of skin substitute procedures, such as split-thickness skin grafts, full-thickness skin grafts, and pedicle flaps. It is important to identify the specific procedure being performed in order to select the appropriate code. Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 1

2. Visit our website: Click here Follow us: Identify the size and location of the graft or flap: The codes in this range are based on the size and location of the skin tissue being replaced. It is important to accurately measure the size of the graft or flap and document the location of the defect in order to select the appropriate code. Choose the appropriate code based on the size and location of the graft or flap: Once the type of procedure and size and location of the graft or flap have been determined, the appropriate CPT code can be selected from the range of codes available. Use any necessary modifiers: Depending on the circumstances of the procedure, it may be necessary to use modifiers to indicate additional information, such as whether the procedure was performed on multiple areas or whether it was a staged procedure. It is important to ensure that the CPT code accurately reflects the specific procedure performed in order to ensure proper reimbursement and compliance with coding regulations. It is recommended to consult with a qualified coding professional or dermatology expert for further guidance on the use of these codes. CPT Codes 19316 – 19396 CPT code range 19316 - 19396 is used for breast reconstruction procedures, including implant- based and autologous tissue-based techniques, used to restore the form and function of the breast following a mastectomy. Following are some guidelines on how to use these reconstructive surgery CPT codes: Determine the type of breast reconstruction procedure being performed: The codes in this range include various types of breast reconstruction procedures, such as implant- based reconstruction and autologous tissue-based reconstruction using flaps. It is important to identify the specific procedure being performed in order to select the appropriate code. Identify whether the procedure is unilateral or bilateral: The codes in this range are Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 2

3. Visit our website: Click here Follow us: divided based on whether the breast reconstruction procedure is unilateral (one side) or bilateral (both sides). It is important to accurately document whether the procedure is being performed on one or both breasts in order to select the appropriate code. Choose the appropriate code based on the type and extent of the reconstruction: Once the type of procedure and unilateral/bilateral nature of the procedure have been determined, the appropriate CPT code can be selected from the range of codes available based on the extent of the reconstruction. Use any necessary modifiers: Depending on the circumstances of the procedure, it may be necessary to use modifiers to indicate additional information, such as whether the procedure was performed at the time of the mastectomy or whether it was a staged reconstruction. CPT Codes 21120 – 21299 CPT code range 21120 - 21299 is used for nasal and facial bone reconstruction procedures, including rhinoplasty and orbital fracture repair, used to restore the form and function of the face following injury or disease. Following are some guidelines on how to use these reconstructive surgery CPT codes: Determine the type of nasal or facial bone reconstruction procedure being performed: The codes in this range include various types of nasal and facial bone reconstruction procedures, such as rhinoplasty, maxillofacial fracture repair, and orbital fracture repair. It is important to identify the specific procedure being performed in order to select the appropriate code. Identify the location and extent of the reconstruction: The codes in this range are based on the location and extent of the nasal or facial bone reconstruction being performed. It is important to accurately document the location and extent of the Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 3

4. Visit our website: Click here Follow us: reconstruction in order to select the appropriate code. Choose the appropriate code based on the specific procedure and extent of the reconstruction: Once the type of procedure and location/extent of the reconstruction have been determined, the appropriate CPT code can be selected from the range of codes available based on the specific procedure and extent of the reconstruction. Use any necessary modifiers: Depending on the circumstances of the procedure, it may be necessary to use modifiers to indicate additional information, such as whether the procedure was performed as a primary or revision procedure or whether it involved multiple procedures or sites. CPT Codes 29806 – 29827 CPT code range 29806 - 29827 is used for shoulder reconstruction procedures, including rotator cuff repair and shoulder replacement, used to restore the function of the shoulder joint following injury or disease. Following are some guidelines on how to use these reconstructive surgery CPT codes: Determine the type of shoulder reconstruction procedure being performed: The codes in this range include various types of shoulder reconstruction procedures, such as rotator cuff repair, labral repair, and shoulder replacement. It is important to identify the specific procedure being performed in order to select the appropriate code. Identify whether the procedure is arthroscopic or open: The codes in this range are divided based on whether the shoulder reconstruction procedure is arthroscopic or open. It is important to accurately document whether the procedure is being performed using an arthroscope or through an open incision in order to select the appropriate code. Choose the appropriate code based on the specific procedure and extent of the Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 4

5. Visit our website: Click here Follow us: reconstruction: Once the type of procedure and arthroscopic or open nature of the procedure have been determined, the appropriate CPT code can be selected from the range of codes available based on the specific procedure and extent of the reconstruction. Use any necessary modifiers: Depending on the circumstances of the procedure, it may be necessary to use modifiers to indicate additional information, such as whether the procedure was performed as a primary or revision procedure or whether it involved multiple procedures or sites. CPT Codes 20900 – 20939 CPT code range 20900 - 20939 is used for hand and wrist reconstruction procedures, including tendon repair and carpal tunnel release, used to restore the function of the hand and wrist following injury or disease. Following are some guidelines on how to use these reconstructive surgery CPT codes: Identify the specific procedure being performed: The codes in this range cover a range of hand and wrist reconstruction procedures, including tendon and ligament repair, fracture reduction, and joint reconstruction. It is important to accurately document the specific procedure being performed in order to select the appropriate code. Determine whether the procedure is performed on the hand or wrist: The codes in this range are divided based on whether the procedure is being performed on the hand or wrist. It is important to accurately document the location of the procedure in order to select the appropriate code. Choose the appropriate code based on the specific procedure and extent of the reconstruction: Once the type of procedure and location of the procedure have been determined, the appropriate CPT code can be selected from the range of codes available Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 5

6. Visit our website: Click here Follow us: based on the specific procedure and extent of the reconstruction. Use any necessary modifiers: Depending on the circumstances of the procedure, it may be necessary to use modifiers to indicate additional information, such as whether the procedure was performed as a primary or revision procedure or whether it involved multiple procedures or sites. We hope that above shared coding guidelines for reconstructive surgery CPT codes might have cleared some coding doubts. It is important to note that these are just a few examples of the CPT codes used in reconstructive surgery, and the appropriate code may vary depending on the specific procedure and circumstances of each case. It is recommended to consult with a qualified plastic surgery coding professional for further guidance. Medical Billers and Coders (MBC) is a professional billing company specializing in plastic surgery. With our expertise in the field of plastic surgery billing and coding, we provide comprehensive and accurate billing services to plastic surgery practices, ensuring timely and maximum reimbursement. We are knowledgeable in the latest CPT codes and regulations related to plastic surgery, and work closely with plastic surgeons to ensure proper documentation and coding of procedures. Our services include claims submission, follow-up, and denial management, as well as revenue cycle management and consulting. MBC helps plastic surgery practices to reduce billing errors, improve revenue, and streamline their billing processes. To know more about our plastic surgery billing and coding services, email us at: info@medicalbillersandcoders.com or call us at: 888-357-3226. CPT: Registered Trademark of American Medical Association (AMA) Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 6