Cracking the Code

DIEP Breast Reconstruction

With a deep inferior epigastric perforator (DIEP) procedure, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up through a person’s chest to rebuild the breast. When coding a DIEP procedure, it is important to remember that the harvesting of the flap is NOT coded separately. With this procedure, the “Replacement” code fully specifies the fact that an autograft was harvested, and the qualifier value describes the DIEP flap.

Q: A 42-year-old female patient who is post mastectomy secondary to breast cancer was admitted for left breast DIEP flap reconstruction with nerve conduit neurotization. The surgeon dissects the abdominal fascia and harvests the perforator flap. The nerve repair is accomplished using a Neurogen alloplastic conduit. The ends of the nerves were secured to the conduit with a suture. Patient tolerated procedure well.
A: 0HRU077, replacement of left breast using deep inferior epigastric artery perforator flap, open approach and 01U80KZ, supplement thoracic nerve with nonautologous tissue substitute, open approach; CPT 19364, breast reconstruction with free flap
Reference: References: ICD-10-PCS Official Guidelines for Coding and Reporting FY 2021 B3.9; CPT ASST February 2015 page 10: Breast reconstruction with flap, correct reporting; AHA Coding Clinic Third Quarter 2019 pages 32-33: Breast reconstruction with neurotization and Third Quarter 2018 page 13: Deep inferior epigastric artery perforator flap breast reconstruction
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