Adjacent Tissue Transfer or Rearrangement

For full-thickness repair of the lip or eyelid, see respective anatomical subsections

CPT Codes 14000-14302 are used for excision (including lesion) and/or repair by adjacent tissue transfer or rearrangement (eg, Z-plasty, W-plasty, V-Y plasty, rotation flap, random island flap, advancement flap). When applied in repairing lacerations, the procedures listed must be performed by the surgeon to accomplish the repair. They do not apply to direct closure or rearrangement of traumatic wounds incidentally resulting in these configurations. Undermining alone of adjacent tissues to achieve closure, without additional incisions, does not constitute adjacent tissue transfer, see complex repair codes 13100-13160. The excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is not separately reportable with codes 14000- 14302.

Skin graft necessary to close secondary defect is considered an additional procedure. For purposes of code selection, the term “defect” includes the primary and secondary defects. The primary defect resulting from the excision and the secondary defect resulting from the flap design to perform the reconstruction are measured together to determine the code.

CPT CODE  14000 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less

CPT code 14000 is used for “Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less.” This code is typically used when a healthcare provider performs an adjacent tissue transfer or rearrangement on the trunk area (chest or back) to repair a defect that is 10 square centimeters or less

Coding Guidelines:

1. Correct Procedure: Ensure that the procedure being coded is indeed an “Adjacent tissue transfer or rearrangement, trunk.” This code is specific to procedures performed on the trunk area.
2. Defect Size: Code 14000 is used for defects that are 10 square centimeters or less. Accurately measure the defect to determine its size. If the defect is larger, a different code may be necessary.
3. Adjacent Tissue Transfer or Rearrangement: This code is used when tissue from the nearby area is transferred or rearranged to cover the defect. This technique is often employed to achieve closure after excision of a lesion or to repair a wound.
4. Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should include details about the location and size of the defect, the technique used for repair, and any special circumstances or considerations.
5. Code Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

Example:

Let’s consider an example where a patient, Mrs. Thompson, has a small skin lesion on her back that needs to be removed. After excising the lesion, the healthcare provider decides to perform an adjacent tissue transfer to close the resulting defect.

1. Mrs. Thompson is brought to the dermatology clinic, where the healthcare provider assesses the skin lesion on her back. The provider determines that the lesion needs to be removed and that an adjacent tissue transfer is the best option for closing the resulting defect, which measures 8 square centimeters.
2. The healthcare provider performs an adjacent tissue transfer to cover the defect on Mrs. Thompson’s back. This involves rearranging or transferring nearby tissue to achieve closure.
3. In the medical billing and coding process, the appropriate CPT code for the procedure, 14000, is used to bill for the adjacent tissue transfer to repair the defect on Mrs. Thompson’s back

CPT CODE -14001  Adjacent tissue transfer or rearrangement, trunk defect 10.1 sq cm to 30.0 sq cm

CPT CODE -14020 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less

CPT code 14020 is used for “Adjacent tissue transfer or rearrangement, scalp, arms, and/or legs; defect 10 sq cm or less.” This code is typically used when a healthcare provider performs an adjacent tissue transfer or rearrangement on the scalp, arms, and/or legs to repair a defect that is 10 square centimeters or less.

Coding Guidelines:

1. Correct Procedure: Ensure that the procedure being coded is indeed an “Adjacent tissue transfer or rearrangement, scalp, arms, and/or legs.” This code is specific to procedures performed on the specified anatomical areas.
2. Defect Size: Code 14020 is used for defects that are 10 square centimeters or less. Accurately measure the defect to determine its size. If the defect is larger, a different code may be necessary.
3. Adjacent Tissue Transfer or Rearrangement: This code is used when tissue from the nearby area is transferred or rearranged to cover the defect. This technique is often employed to achieve closure after excision of a lesion or to repair a wound.
4. Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should include details about the location and size of the defect, the technique used for repair, and any special circumstances or considerations.
5. Code Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

Example:

Let’s consider an example where a patient, Mr. Harris, has a small skin lesion on his forearm that needs to be removed. After excising the lesion, the healthcare provider decides to perform an adjacent tissue transfer to close the resulting defect.

1. Mr. Harris visits the dermatology clinic, where the healthcare provider assesses the skin lesion on his forearm. The provider determines that the lesion needs to be removed, and an adjacent tissue transfer is the best option for closing the resulting defect, which measures 9 square centimeters.
2. The healthcare provider performs an adjacent tissue transfer to cover the defect on Mr. Harris’s forearm. This involves rearranging or transferring nearby tissue to achieve closure.
3. In the medical billing and coding process, the appropriate CPT code for the procedure, 14020, is used to bill for the adjacent tissue transfer to repair the defect on Mr. Harris’s forearm.

CPT CODE -14021 Adjacent tissue transfer or rearrangement, scalp, arms, and/or legs defect 10.1 sq cm to 30.0 sq cm

CPT CODE -14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; defect 10 sq cm or less

CPT code 14040 is used for “Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less.” This code is typically used when a healthcare provider performs an adjacent tissue transfer or rearrangement on the specified anatomical areas to repair a defect that is 10 square centimeters or less

Coding Guidelines:

1. Correct Procedure: Ensure that the procedure being coded is indeed an “Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet.” This code is specific to procedures performed on these specified anatomical areas.
2. Defect Size: Code 14040 is used for defects that are 10 square centimeters or less. Accurately measure the defect to determine its size. If the defect is larger, a different code may be necessary.
3. Adjacent Tissue Transfer or Rearrangement: This code is used when tissue from the nearby area is transferred or rearranged to cover the defect. This technique is often employed to achieve closure after excision of a lesion or to repair a wound.
4. Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should include details about the location and size of the defect, the technique used for repair, and any special circumstances or considerations.
5. Code Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

Example:

Let’s consider an example where a patient, Ms. Rodriguez, has a small skin lesion on her cheek that needs to be removed. After excising the lesion, the healthcare provider decides to perform an adjacent tissue transfer to close the resulting defect.

1. Ms. Rodriguez visits the dermatology clinic, where the healthcare provider assesses the skin lesion on her cheek. The provider determines that the lesion needs to be removed and that an adjacent tissue transfer is the best option for closing the resulting defect, which measures 7 square centimeters.
2. The healthcare provider performs an adjacent tissue transfer to cover the defect on Ms. Rodriguez’s cheek. This involves rearranging or transferring nearby tissue to achieve closure.
3. In the medical billing and coding process, the appropriate CPT code for the procedure, 14040, is used to bill for the adjacent tissue transfer to repair the defect on Ms. Rodriguez’s cheek.

CPT CODE -14041 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet defect 10.1 sq cm to 30.0 sq cm

CPT CODE -14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears, and/or lips; defect 10 sq cm or less

CPT code 14060 is used for “Adjacent tissue transfer or rearrangement, eyelids, nose, ears, and/or lips; defect 10 sq cm or less.” This code is typically used when a healthcare provider performs an adjacent tissue transfer or rearrangement on the specified anatomical areas (eyelids, nose, ears, and/or lips) to repair a defect that is 10 square centimeters or less

Coding Guidelines:

1. Correct Procedure: Ensure that the procedure being coded is indeed an “Adjacent tissue transfer or rearrangement, eyelids, nose, ears, and/or lips.” This code is specific to procedures performed on these specified anatomical areas.
2. Defect Size: Code 14060 is used for defects that are 10 square centimeters or less. Accurately measure the defect to determine its size. If the defect is larger, a different code may be necessary.
3. Adjacent Tissue Transfer or Rearrangement: This code is used when tissue from the nearby area is transferred or rearranged to cover the defect. This technique is often employed to achieve closure after excision of a lesion or to repair a wound.
4. Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should include details about the location and size of the defect, the technique used for repair, and any special circumstances or considerations.
5. Code Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

Example:

Let’s consider an example where a patient, Mr. Thompson, has a small lesion on his lower lip that needs to be removed. After excising the lesion, the healthcare provider decides to perform an adjacent tissue transfer to close the resulting defect.

1. Mr. Thompson visits the dermatology clinic, where the healthcare provider assesses the lesion on his lower lip. The provider determines that the lesion needs to be removed, and an adjacent tissue transfer is the best option for closing the resulting defect, which measures 6 square centimeters.
2. The healthcare provider performs an adjacent tissue transfer to cover the defect on Mr. Thompson’s lower lip. This involves rearranging or transferring nearby tissue to achieve closure.
3. In the medical billing and coding process, the appropriate CPT code for the procedure, 14060, is used to bill for the adjacent tissue transfer to repair the defect on Mr. Thompson’s lower lip.

CPT CODE -14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears, and/or lips defect 10.1 sq cm to 30.0 sq cm
(For eyelid, full thickness, see 67961 et seq)

CPT CODE -14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm

CPT code 14301 is used for “Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm.” This code is typically used when a healthcare provider performs an adjacent tissue transfer or rearrangement on any anatomical area to repair a defect that is between 30.1 and 60.0 square centimeters.

Coding Guidelines:

1. Correct Procedure: Ensure that the procedure being coded is indeed an “Adjacent tissue transfer or rearrangement, any area.” This code is not specific to a particular anatomical area but is used for defects on any part of the body.
2. Defect Size: Code 14301 is used for defects that range from 30.1 to 60.0 square centimeters. Accurately measure the defect to determine its size. If the defect is smaller or larger, a different code may be necessary.
3. Adjacent Tissue Transfer or Rearrangement: This code is used when tissue from the nearby area is transferred or rearranged to cover the defect. This technique is often employed to achieve closure after excision of a lesion or to repair a wound.
4. Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should include details about the location and size of the defect, the technique used for repair, and any special circumstances or considerations.
5. Code Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

Example:

Let’s consider an example where a patient, Ms. Johnson, has a large skin lesion on her thigh that needs to be removed. After excising the lesion, the healthcare provider decides to perform an adjacent tissue transfer to close the resulting defect, which measures 40 square centimeters.

1. Ms. Johnson visits the dermatology clinic, where the healthcare provider assesses the lesion on her thigh. The provider determines that the lesion needs to be removed, and an adjacent tissue transfer is the best option for closing the resulting defect, which measures 40 square centimeters.
2. The healthcare provider performs an adjacent tissue transfer to cover the defect on Ms. Johnson’s thigh. This involves rearranging or transferring nearby tissue to achieve closure.
3. In the medical billing and coding process, the appropriate CPT code for the procedure, 14301, is used to bill for the adjacent tissue transfer to repair the defect on Ms. Johnson’s thigh.

CPT CODE -✚ 14302 Adjacent tissue transfer or rearrangement, any area each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure)
(Use 14302 in conjunction with 14301)

CPT CODE -14350 Filleted finger or toe flap, including preparation of recipient site

CPT code 14350 is used for “Filleted finger or toe flap, including preparation of recipient site.” This code is typically used when a healthcare provider performs a surgical procedure to create a filleted finger or toe flap and prepares the recipient site. Filleted flaps involve transferring tissue from a finger or toe to another location, usually to cover a defect or wound in a different area of the body.

Coding Guidelines:

1. Correct Procedure: Ensure that the procedure being coded is indeed a “Filleted finger or toe flap, including preparation of recipient site.” This code is specific to the creation of filleted flaps and the preparation of the recipient site.
2. Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should include details about the reason for performing the filleted flap, the location and size of the defect, the technique used for creating the flap, and any special circumstances or considerations.
3. Recipient Site Preparation: This code includes the preparation of the recipient site, which involves getting the area ready to receive the filleted flap. This may include debridement, shaping, and other necessary steps to ensure the successful transfer and integration of the flap.
4. Code Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

Example:

Let’s consider an example where a patient, Mr. Anderson, has a complex wound on his forearm that requires a soft tissue reconstruction. The healthcare provider decides to perform a filleted finger flap from the adjacent finger to cover the wound.

1. Mr. Anderson is brought to the surgical suite, where the healthcare provider assesses the wound on his forearm. The provider determines that a filleted finger flap is the most suitable option to achieve soft tissue reconstruction.
2. The healthcare provider performs the filleted finger flap procedure, carefully transferring tissue from the adjacent finger to cover the wound on Mr. Anderson’s forearm. This involves intricate surgical techniques to create the flap and secure it in place.
3. The provider also prepares the recipient site on Mr. Anderson’s forearm, ensuring that it is ready to receive the filleted finger flap. This may involve debridement, shaping the recipient site, and other steps to optimize the success of the procedure.
4. In the medical billing and coding process, the appropriate CPT code for the procedure, 14350, is used to bill for the filleted finger or toe flap, including the preparation of the recipient site.

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