Author Topic: Inferior Dermal Pedicle Flap  (Read 241 times)

ashleys

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Inferior Dermal Pedicle Flap
« on: September 05, 2017, 03:23:58 PM »
I need help coding a surgery.  Is the inferior dermal pedicle flap billed out separately from the mastectomy or is it included?  If it can be billed, what CPT code would I use?  Please help coding this surgery.    I have posted part of the operative report.  Thanking you in advance!


The inferior dermal pedicle flap was then drawn out.  The patient was

injected in the subdermal injection on the right breast with radioactive sulfur

colloid.  Deepithelialization was carried out of the inferior dermal pedicle

flap.  The reduction-type pattern incision was then made with the Megadyne

PlasmaBlade and the inferior dermal pedicle flap was fashioned contiguous with

the inframammary fold.  Flaps were then formed superiorly, medially, inferior to

 the inframammary fold, and lateral to latissimus dorsi muscle.  Dissection was

carried down to the chest wall.  The breast was removed from the chest wall,

medial to lateral, inclusive of the pectoralis fascia.  The breast was oriented

with silk suture, short superior margin and long lateral.  Attention was turned

to the right axilla.  Utilizing the Neoprobe, the significant radioactive node

was identified.  This was clamped with an Allis clamp and excised.  Faxitron

documented the presence of the clip of the node that had been previously

biopsied.  This was sent for frozen section.  It had not been down-staged; one

node was positive, one node was negative.  Additional tissue was taken from the

axilla.  Clinically enlarged nodes were again clamped with an Allis clamp.  This

 was excised and sent for permanent section.  Individual bleeders were

Ligaclipped.  The area was irrigated with normal saline solution.  Intercostal

brachial long thoracic and thoracodorsal nerves were identified and preserved. 

The area was injected with 30 mL of Exparel; 20 mL of Exparel was diluted with

40 mL of normal saline.  Attention was turned to the left breast where a mirror

image incision was made.  The inferior dermal pedicle flap was deepithelialized

and fashioned contiguous with the inframammary fold.  The reduction type pattern

 was then made with the inferior dermal pedicle flap.  Flaps were then formed

superiorly, medially, inferior to the inframammary fold, and lateral to

latissimus dorsi muscle.  Dissection was carried down to the chest wall.  The

breast was removed from the chest wall, medial to lateral, inclusive of the

pectoralis fascia.  The breast was oriented with silk suture, short superior

margin and long lateral.  Again, individual bleeders were Ligaclipped.  The area

 was irrigated with normal saline solution.  The inferior dermal pedicle flap

was then attached to the chest wall utilizing interrupted 3-0 PDS.  A #19 Blake

drain was brought out through a separate stab incision and secured in place with

 2-0 silk.  Both incisions were then closed utilizing interrupted 3-0 PDS and

running subcuticular sutures of 4-0 Monocryl.  Dermabond was placed, Adaptic, 4

x 4, ABD, front closure bra and a 6-inch Ace was used for moderate pressure.
« Last Edit: September 05, 2017, 03:41:42 PM by ashleys »

Michele

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Re: Inferior Dermal Pedicle Flap
« Reply #1 on: September 07, 2017, 08:52:50 AM »
I am not a certified coder so I cannot code the example below.  However, from reading your question I would suggest that you bill both procedures if both procedures were performed.  The patient's insurance will determine if the inferior dermal pediicle flap is allowed separately or not.
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ashleys

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Re: Inferior Dermal Pedicle Flap
« Reply #2 on: September 07, 2017, 01:28:21 PM »
Thank you for responding.  My main question is what CPT code would I use for the inferior dermal pedicle flap?

Michele

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Re: Inferior Dermal Pedicle Flap
« Reply #3 on: September 08, 2017, 07:25:03 AM »
It appears that the example below is for the mastectomy, not the reconstruction.  In that case I believe the inferior dermal pedicle flap is part of the mastectomy.  If it is the reconstruction I found the following which has a lot of information:

https://www.oxhp.com/secure/policy/breast_reconstruction_post_mastectomy.pdf 

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