AHA Coding Clinic® for HCPCS - 2024 Issue 1; Ask the Editor

Retrieval and implantation of “banked” rib cartilage grafts

A patient with a paramedian forehead flap presented for flap takedown, nasal reconstruction revision and vestibular stenosis repair with structural grafting. During the first surgery, cartilage grafts were harvested from the patient’s rib and then stored “banked’ in the patient’s thigh, for later use. After anesthesia administration, an incision was made through to the superficial subcutaneous tissue at the site of the previous thigh scar; the cartilaginous grafts were identified. All five previously banked pieces of cartilage were placed into a sterile solution. Turning to the nose, the paramedian forehead flap was divided from the columellar inset, but remained pedicled at the brow. One piece of the retrieved cartilage was chosen for the dorsal construct and another piece was chosen for the columellar construct and trimmed appropriately. A pocket was created in the center of the columellar construct. The skin of the dorsum was divided and back elevated, to release scar tissue and for upward tethering of the nasal tip.The columellar strut was placed into the soft tissue columellar reconstruction and the dorsal strut was fixed to dorsal soft tissue using sutures. This provided nasal projection and tip support. The forehead flap reconstructing the columella was inset to the nasal tip using sutures. The pedicled forehead flap at the brow was trimmed and inset into the dorsum using sutures. Local tissue rearrangement measured less than 30 cm².Following irrigation and hemostasis of the thigh wound, the five remaining pieces of cartilage were placed superficial to muscle and the wound was closed in layers. For outpatient facility reporting, is it appropriate to report CPT code 21230 for the “banked” cartilage grafts retrieved from the thigh and implanted into the nose? Does “includes obtaining graft” in the code descriptor of 21230 mean “when performed”- in such that graft harvesting at the same surgical session is not required in order to assign the code? How is the retrieval and implantation of the rib grafts reported? ...

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