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Tissue Grafting Procedures Coding Updates


Article-Tissue-Grafting-Procedures-Coding-Updates

The American Medical Association (AMA) Specialty Relative Value Scale (RVS) Update Committee (RUC) identified code 20926, Tissue grafts, other (e.g., paratenon, fat, dermis), as potentially mis-valued. This code represented many different types of tissue grafts that required different physician work. For 2020, code 20926 will be deleted and replaced with five new codes (15769, 15771–15774) in the Integumentary System, Other Flaps and Grafts subsection. 

CPT code 15771 is a brand-new code that essentially replaces code 20926 and describes new technology to perform tissue transfer that was unavailable at the time the original code was established. Four additional codes, 15771-15774, were created in addition to CPT code 15769, to describe the use of autologous fat grafting harvested by liposuction technique, prepared with centrifugation, and then injected in multiple small aliquots to fill a soft tissue defect. These codes are volume-based and include both a base code and add-on code depending on the area of the body grafted.

Other Soft Tissue

CPT 15769: Grafting of autologous soft tissue, other, harvested by direct excision (e.g., fat, dermis, fascia): CPT code 15769 was created to describe the excision of a block of soft tissue and then placement into the defect. This code is, in essence, a replacement for CPT code 20926. The previous code served as a catch-all code and reflected multiple methods and approaches for obtaining grafting material which are now better identified with greater specification in the newly created code set.

The RUC recommends these physician time components: 38 minutes of pre-service time (25 minutes evaluation time, 3 minutes positioning time, 10 minutes scrub/dress/wait time), 45 minutes of intra-service time and 15 minutes of immediate post-service time, 1-99238 discharge management, 1-99213 and 2-99212 office visits. Unlike the rest of the code family, an overnight stay for the patient is typical for CPT code 15769.

Fat: Trunk, Breasts, Scalp, Arms, Legs

CPT Code 15771: Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50cc or less injectate: The RUC recommends the following physician time components: 50 minutes of pre-service time (30 minutes evaluation time, 10 minutes positioning time, 10 minutes scrub/dress/wait time), 60 minutes of intraservice time, and 16 minutes of immediate post-service time, 1-99213 and 2-99212 office visits. 

CPT Code 15772: Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50cc injectate, or part thereof (List separately in addition to code for primary procedure): CPT code 15772 is the add-on code for autologous fat grafting to the trunk, breasts, extremities, or scalp for each additional 50cc of injectate. This volume was derived from the typical amount of injectable fat obtained from one round of centrifugation. The RUC recommends 45 minutes of intra-service time. That time is justified because for each additional 50cc, the work is essentially duplicated. The only work that is different is the surgeon does not have to open and close the access site.

Fat: Face, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet

CPT Code 15773: Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25cc or less injectate: CPT code 15773 is the base-code for autologous fat grafting to the sensitive areas of the face, hands, feet, and genitalia for up to 25cc of injectate. This volume was derived from the typical volume of fat grafted into these smaller areas compared to the trunk. The RUC recommends the following physician time components: 50 minutes of pre-service time (30 minutes evaluation time, 10 minutes positioning time, 10 minutes scrub/dress/wait time), 60 minutes of intra-service time and 15 minutes of immediate post-service time, 1-99213 and 2- 99212 office visits. 

CPT Code 15774: Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25cc injectate, or part thereof (List separately in addition to code for primary procedure): CPT code 15774 is the add-on code for autologous fat grafting to the sensitive areas of the face, hands, feet, and genitalia for up to 25cc of injectate. This volume was derived from the typical volume of fat grafted into these smaller areas compared to the trunk. The RUC recommends 45 minutes of intra-service. Similar to CPT code 15772, that time is justified because for each additional 25cc, the work is essentially duplicated. It is a smaller volume of injectate than in code 15772 but in more difficult areas.

CPT Code 15771 to +15774

CPT Code

Global Period

Work RVU

Total FAC-RVU

15769

90

6.68

13.86

15771

90

6.73

13.76

+15772

-

2.50

4.07

15773

90

6.83

13.91

+15774

-

2.41

3.91

 

The four new codes, 15771 to +15774, apply to autologous fat grafting harvested using liposuction. You’ll choose from fat grafting codes 15771 to +15774 based on the body part or parts where the grafts are placed and the total injectate. When you read the descriptors, remember that the body parts listed, such as ‘trunk, breasts, scalp, arms, and/or legs’ in 15771, are the recipient sites. You don’t choose the code based on the donor site.

Each code from 15771 to +15774 includes a number reflecting the volume of the total amount of injectate. The word ‘total’ is important here. ‘For multiple sites of injection, sum the total volume of injectate to anatomic sites that are grouped together into the same code descriptor,’ the CPT® guidelines state. Based on this instruction, you will report 50 cc of injectate injected into the face and mouth using both 15773 (25 cc or less) and +15774 (each additional 25 cc or part thereof).

Do you report soft tissue grafts? Do you wish code descriptors were longer and more specific so you didn’t have to search guidelines for clarification? Medical Billers and Coders (MBC) provides medical billing and coding services that ensure on-time and accurate billing. We understand the importance of entering the right information so there are no delays or denials on behalf of the insurance provider. To know more about our billing services, you can contact us at 888-357-3226/ info@medicalbillersandcoders.com

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