FEDERAL | ASPS Defends the Medicare Payment Rates for the Myocutaneous Flap Family

ASPS actively participates in the AMA Current Procedural Terminology (CPT and) Relative Value Scale (RVS) Update Committee (RUC) Panels, which are charged with creating new CPT codes and updating existing codes used to report medical evaluations and procedures. In late 2015, the family of muscle flap codes (15732-15738) was flagged for review by CMS due to several billing anomalies, including a significant change in the typical provider billing these codes.

ASPS has long held that the muscle flap family of codes describe extensive procedures comprising muscle dissection, disorigination and/or disinsertion, preservation of a vascular pedicle, and transfer. Together with the American Association of Hand Surgery, as well as the American College of Surgeons, the ASPS Advisors to the CPT and RUC panels were successful in defending the existing work Relative Value Unit (RVU) values for three of the four codes – myocutaneous flaps to the abdomen, upper extremity and lower extremities.

Unfortunately, code 15732, which is defined as a flap to the head and neck, was singled out as an area where further delineation in procedure coding would be necessary.

Our colleagues at the American Academy of Ophthalmology were charged with creating a code for a midface flap (i.e. zygomaticofacial) with preservation of vascular pedicle(s), to describe the work they typically perform. ASPS was charged with updating the description of the existing code, including a mandate to include key words such as temporalis and sternocleidomastoid in the new code descriptor.

This January, both codes were successfully defended and approved for addition in the 2018 CPT book. Once CMS reviews the proposal, and publishes their comments in a Proposed Rule, ASPS will share detailed information on the changes and the expected impact to Plastic Surgery billing.