Coverage Limitations and Exclusions for CPT code 14020 & 14021

Procedures that correct an anatomical Congenital Anomaly without improving or restoring physiologic function are considered Cosmetic procedures; the fact that a Covered Person may suffer psychological consequences or socially avoidant behavior as a result of an Injury, Sickness or Congenital Anomaly does not classify surgery (or other procedures done to relieve such consequences or behavior) as a reconstructive procedure. CPT code 14020 & 14021 are some procedure codes used to report the adjacent tissue transfer exams.

Procedures that do not meet the reconstructive criteria in the Indications for Coverage section

• Pharmacological regimens, nutritional procedures or treatments
• Scar or tattoo removal or revision procedures (such as salabrasion, chemosurgery and other such skin abrasion procedures) o Skin abrasion procedures performed as a treatment for acne
• Liposuction or removal of fat deposits considered undesirable, including fat accumulation under the male breast and nipple
• Treatment for skin wrinkles or any treatment to improve the appearance of the skin o Treatment for spider veins
• Sclerotherapy treatment of veins Note: Sclerotherapy in excess of 3 sessions per leg is considered cosmetic o Hair removal or replacement by any means

Procedure performed for CPT code 14020 & 14021

Adjacent Tissue Transfer: A random pattern local flap which is used to fill in nearby or local defect. To be considered an Adjacent Tissue Transfer an incision must be made by the surgeon which results in a secondary defect. Examples include; transposition flaps, advancement flaps and rotation flaps.

The physician transfers or rearranges adjacent tissue to repair traumatic or surgical wounds of the scalp, arms, and/or legs. This includes, but is not limited to, such rearrangement procedures as Z-plasty, W-plasty, ZY-plasty, or tissue transfers such as rotational or advancement flaps. CPT code 14020 is reported for defects that are 10 sq cm or less and CPT code 14021 for defects that are 10.1 sq cm to 30 sq cm.

If two lesions from the same anatomical classification are removed, with both of the resulting defects requiring adjacent tissue transfer closure, the appropriate code from the 14000-14302 series may be reported for each tissue transfer (eg, flap advancement) performed, provided the defects have distinct margins and are not contiguous.

Codes 14000-14302 are used for excision (including lesion) and/ or repair by adjacent tissue transfer or rearrangement (e.g., Z-plasty, W-plasty, V-Y plasty, rotation flap, random island flap, advancement flap). The primary defect resulting from the excision and the secondary defect resulting from flap design to perform the reconstruction are measured together to determine the code. Skin graft necessary to close a secondary defect is considered an additional procedure.

Related procedure codes for CPT code 14020 & 14021

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

14001 Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm

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

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

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

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

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

14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm

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

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)

Read also: How to become 99% perfect in surgery coding

Coding rules for CPT code 14020 & 14021

The CPT guidelines have some very specific rules regarding coding adjacent tissue transfer that it is important to understand to ensure proper use of these codes.

Rule #1: If the edges of a wound are “undermined” (lifted up and mobilized) without creating any additional incisions, this is not an adjacent tissue transfer. CPT states that for undermining alone, you should code a complex repair code (CPT codes 13100-13160).

Rule #2: If a traumatic wound is in a shape that “incidentally” results in one of the techniques we just discussed for adjacent tissue transfer (e.g, a W-plasty), this is also not an adjacent tissue transfer. To code adjacent tissue transfer, the surgeon must make incisions and intentionally create the shapes/flaps that meet the definition of adjacent tissue transfer.

Rule #3: Because adjacent tissue transfer can be reported for repair of a defect following excision of a lesion, the excision of a lesion at the same anatomic site as an adjacent tissue transfer is not separately coded. Do not report codes 11400-11446 or 11600-11646 for excision of benign or malignant skin lesions at the site of adjacent tissue transfer.

Rule #4: Adjacent tissue transfer is coded based on the total square centimeters of area repaired with adjacent tissue transfer techniques. When coding adjacent tissue transfer, the term “defect” refers to the primary defect (the area needing repair in the first place) and the secondary defect (any defect created by the effort of designing and mobilizing a flap) together. Add together the total square centimeters of the primary and secondary defect areas to get your total area for repair. Coding tip: Sometimes a surgeon will give you the total area in terms of square centimeters but other times you have to calculate that yourself. If the surgeon provides measurements of the length and width of a wound in centimeters, multiply those measurements together to get your total square centimeters. For example, if a surgeon stated that a traumatic laceration on the arm was 8 cm x 2 cm, and that wound was repaired with a W-plasty, I would multiply 8 x2 to arrive at 16 square centimeters of area for my adjacent tissue transfer code.

Rule #5: If two non-contiguous areas (two areas that are not touching and have distinct margins) are repaired with adjacent tissue transfer and those anatomic areas happen to fall under the same range of CPT codes for a defect that is 30 sq cm or smaller, report separate adjacent tissue transfer codes for each area. For example, if the surgeon performs a rotational flap for an area that is 7 x2 cm on the neck and then an advancement flap for an area that is 3 x4 cm on the foot, you would code 14041 x1 for the adjacent tissue transfer of 14 sq cm on the neck and then 14041 x1 again for the adjacent tissue transfer of 12 sq cm on the foot. On the second line of code with CPT 14041, you would report either modifier 51 or modifier 59 (depending on payer guidelines).