CPT Knowledgebase - Mar 26, 2014

Occasionally when a free flap breast reconstruction is performed (code 19364), one of the arteries or veins anastomosed for the free flap becomes thrombosed, resulting in the need for a new vascular anastomosis. Some surgeons report the appropriate anatomic blood vessel repair codes within the 35201-35286 code series for the re-anastomosis. It is my understanding of the blood vessel repair codes that the definition or intent of these codes does not meet the re-anastomosis in free flap breast reconstruction, and the use of modifier 22, Increased Procedural Services, would be more appropriate if the surgeon documented the extra time, work, and effort involved in resolving this complication. Which method of reporting is correct?

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