what is local tissue rearrangement

Breast reconstruction via local tissue rearrangement refers to a procedure that rearranges breast tissue after a lumpectomy to create a Breast Reduction or a Breast Lift.

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How is an adjacent tissue transfer or rearrangement performed?

An adjacent tissue transfer or rearrangement is performed in two stages. The first stage is when the local flap is taken from the donor site and sewn into the site where the lesion or skin defect is located.

What are adjacent tissue transfer flaps?

Per CPT® Assistant July 2008, Volume 18: Issue 7, Coding Communication, Adjacent tissue transfer or rearrangement procedures (local flaps) are also referred to as “rotation flaps”, “transposition flaps” and “advancement flaps”. A rotation flap is a curvilinear flap that closes a defect by a rotating the skin around a pivot point.

What is an attachable tissue transfer?

An adjacent tissue transfer, also known as a rearrangement procedure or simply ATT/R, is a medical procedure wherein flat sections of healthy skin and other tissues are transferred or transplanted to the area adjacent to a skin defect.

What is CPT code for tissue transfer and rearrangement?

Tissue transfer and rearrangement requires that adjacent tissue be incised and carried over to close a wound or defect. The CPT® code book classifies repairs (closure) (CPT® codes 12001-13160) as simple, intermediate, or complex.

What is ATT in medical coding?

Abbreviations ART: Antiretroviral therapy; ATT: Anti-tuberculosis...

What is the difference between adjacent tissue transfer and flap?

Moderator, CCO Instructor. Tissue transfer is when they take tissue from someplace else and cover the wound. A flap is also taking tissue but from close to the woud and it is flopped over the wound.

Is repair included in adjacent tissue transfer?

Adjacent tissue transfer or rearrangement procedures include excision (CPT codes 11400-11646) and repair (12001-13160).

What is soft tissue transfer?

Free tissue transfer is defined as the vascular dissection and detachment of an isolated and specific region of the body (eg, skin, fat, muscle, bone) and transfer of said tissue to another region of the body, with anastomosis of the divided artery and vein to a separate artery and vein located at the site of the ...

How do you determine the size of an adjacent tissue transfer?

If the adjacent tissue transfer closed both the primary defect and the secondary defect, add both the size of primary defect plus the size of the secondary defect to determine the size of the flap that is coded.

Which kind of surgery is also known as flap surgery?

Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels.

What is tissue transfer repair of wound?

Definition & Overview An adjacent tissue transfer, also known as a rearrangement procedure or simply ATT/R, is a medical procedure wherein flat sections of healthy skin and other tissues are transferred or transplanted to the area adjacent to a skin defect.

Is local anesthesia included in the surgical package?

Local anesthesia by the surgeon is included in the surgical payment.

Is debridement included in adjacent tissue transfer?

Adjacent tissue transfer or rearrangement procedures include excision (CPT® codes 11400-11646) and repair (CPT® codes 12001-13160) and debridement (e.g., CPT® codes 11000-11001, 11004-11006, 11042-11047, 97597, 97602).

How do tissues transfer?

In tissue transfer, the plastic surgeon removes tissue, including skin, fat, muscle, nerves and bone, from one part of the body and moves it to the part of the body where it is needed. The arteries and veins are re-attached and, in some cases, the nerves are as well.

Can you transplant breast tissue?

About Breast Reconstruction Using a Tissue Transfer Breast reconstruction using a tissue transfer is a surgery that uses fat, skin, and sometimes muscle from another part of your body (called the donor site) to create a new breast. The donor site can be your abdomen (belly), back, buttocks, or inner thigh.

How long does it take to recover from free flap surgery?

You will need to follow the following guidelines until your incisions completely heal. This is usually 6 weeks after your surgery. Your doctor will tell you how long to follow these guidelines for.

What is included with adjacent tissue transfer?

Definition & Overview. An adjacent tissue transfer, also known as a rearrangement procedure or simply ATT/R, is a medical procedure wherein flat sections of healthy skin and other tissues are transferred or transplanted to the area adjacent to a skin defect.

What is flap in medical term?

flap) A type of surgery used to rebuild the shape of the breast after a mastectomy. A tissue flap, including blood vessels, skin, fat, and sometimes muscle, is removed from one area of the body, such as the back or abdomen.

Is debridement included in adjacent tissue transfer?

Adjacent tissue transfer or rearrangement procedures include excision (CPT® codes 11400-11646) and repair (CPT® codes 12001-13160) and debridement (e.g., CPT® codes 11000-11001, 11004-11006, 11042-11047, 97597, 97602).

What is a fascial flap?

Fasciocutaneous flaps are tissue flaps that include skin, subcutaneous tissue and the underlying fascia. Including the deep fascia with its prefascial and subfascial plexus enhances the circulation of these flaps. They can be raised without skin and are then referred to as fascial flaps.

What type of flaps are used for breast reconstruction?

Usually, the reconstruction techniques are performed with one of five surgical options: breast tissue advancement flaps, local flaps, bilateral mammaplasty, latissimus dorsi myocutaneous flaps, and complete skin-sparing mastectomy with total reconstruction. The main indications for LTR are for types IA, IIA, and IIIA. In this scenario breast defects are reconstructed with breast tissue advancement flaps in which the defect created is usually spherical or rectangular. The breast tissue is advanced along the chest wall or beneath the breast skin flap to fill the tumor defect.

What is LTR technique?

LTR techniques are defined when the BCS defect is reconstructed using one of a range of breast or local flaps, advanced into the lumpectomy defect. Different techniques have been described to repair small or moderate defects. These procedures are all based on advancement or rotation of an area of breast or local tissue to reconstruct the BCS. According to the breast volume, ptosis, and tumor size/location, the patients are evaluated by the plastic surgeon who decides each type of indicated reconstruction. During intraoperative evaluation, the partial breast defects in relation to the initial breast volume, the size and location of the defect, and the amount of tissue available are evaluated and an appropriate procedure can be selected ( Box 16.2).

What is LTR in breast surgery?

This chapter describes local tissue rearrangement (LTR) techniques, which allow the use of remaining breast/local tissue following BCS by glandular flaps, local flaps or glandular reshaping techniques for better aesthetic results. Thorough understanding of these techniques and an adequate consideration of the patient’s breast volume, tumor location, excised volume, and volume of the remaining breast tissue in choosing appropriate surgical techniques will result in a satisfactory outcome. In some cases and depending on the excised volume and the initial breast volume, surgery of the contralateral breast may be necessary to improve symmetry. In addition, the timing of such surgery and the advantages of synchronous versus delayed approaches should also be pointed out.

What is a lateral thoracodorsal flap?

In type IB, the lateral thoracodorsal flap can be indicated for lateral defects. This flap can be planned as a wedge-shaped triangle located on the lateral aspect of the thorax and then rotated to the breast defect. For small defects, the flap is planned as a triangle located exclusively on the lateral aspect of the thorax. In type IIB, breast defects are most frequently reconstructed with breast tissue advancement flaps and associated mastopexy techniques. The same concept can be applied for types IIIA and IIIB. Defects classified as C (I, II and III) are not adequate to be reconstructed by LTR.

What is BCS reconstruction?

BCS reconstruction consists of a concept that combines BCS with techniques of breast reshaping in order to improve the final aesthetic outcome and to expand the indications for breast conservation without decreasing oncological safety.

What are the best procedures for BCS reconstruction?

Recently, increasing attention has been focused on BCS reconstructive procedures. Among the main techniques, glandular flaps, skin /fat local flaps and mastopexy/mammaplasty are most commonly used with more satisfactory results. The selection of a best technique is determined by the surgeon’s experience and the volume of the BCS defect in relation to the volume of the remaining breast tissue. The main positive aspects of the reconstructive technique should include reproducibility, low interference with the oncologic treatment and long-term results ( Box 16.1).

What is the LTA in breast?

The LTA usually arises from the axillary artery and supplies up to 30% of breast blood flow to the lateral and upper outer aspects of the breast. The branches course inferomedially within the subcutaneous tissue to effect anastomoses with branches of the internal mammary artery (IMA) and internal carotid artery (ICA) in the areolar area. The III, IV, and V posterior ICA are the least important arteries supplying the breast.

How is skin tissue rearrangement performed?

Skin tissue rearrangement is performed through surgical methods and requires the use of anaesthetics. The amount of anesthetics used is decided based on the type of surgery to be performed and if the patient will need to be asleep during the process.

What is skin tissue rearrangement?

Skin tissue rearrangement is ideal for patients with large lesions, scars, burns, and those scheduled for foreign body removal. It is specifically recommended for those who have damaged skin on body parts that cannot be hidden by clothing. However, patients who simply do not like the appearance of the scar may also opt to undergo the procedure.

How to do a skin graft?

For the graft procedure, the surgeon will start by removing the damaged skin using a wide excision technique. A healthy skin from the donor site is then harvested and transplanted to the recipient site. All the wounds are then closed using sutures. In some cases, patients may need to undergo several incision and drainage procedures while in recovery to prevent infection and fluid buildup as well as hasten the healing process.

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Can a scar be removed from a burn?

In some cases, such as those involving hyperkeratotic lesions, the old scar is surgically removed and the resulting wound is sutured in a way that will create a less visible scar. However, if the damage is too large, a tissue rearrangement procedure, such as adjacent tissue transfer, may be necessary. This involves the removal of healthy skin tissue (grafts) from other parts of the body and using it to cover the damaged skin. The procedure is standard in the management of severe burn cases.

Can skin grafts be treated?

The donor site where the skin graft was harvested will be treated and protected until it is completely healed. Patients are then informed that even when the wounds heal properly at the transplanted site, scarring may still be slightly noticeable after the suture removal process to manage their expectations.

Can scars be made less visible?

Having large scars can seriously affect a person’s confidence, especially if clothing can’t conceal them. However, they can be made less conspicuous with skin tissue rearrangement. The procedure, which can be performed several ways using a variety of techniques (e.g., punch revision and scar revision), aims to reduce the appearance of scars by rearranging the tissue.

How is tissue transfer performed?

The first stage is when the local flap is taken from the donor site and sewn into the site where the lesion or skin defect is located. The two sites are connected together by a bridge of tissue called the flap pedicle, which provides continuous blood supply to the local flap for a couple of weeks.

What is tissue transfer?

An adjacent tissue transfer, also known as a rearrangement procedure or simply ATT/R, is a medical procedure wherein flat sections of healthy skin and other tissues are transferred or transplanted to the area adjacent to a skin defect. These sections of tissue are called local flaps and are used to cover up defects or lesions on the surface of the skin. This procedure, which can be performed on any part of the body, including the trunk, scalp, arms, and legs, promises better cosmetic results because the donor skin and the skin immediately surrounding the wound or lesion have the same features.

What is a donor site flap?

The donor site is the same body part, with the flap being taken from the area adjacent to the skin defect that has to be covered up.

What is the advantage of tissue transfer?

The main advantage of an adjacent tissue transfer over skin or tissue graft is that a part of the flap remains connected to its origin. This way, the flap has an intact and continuous blood supply. This means that the tissue will not lose blood supply even while waiting for new blood vessels to grow on the recipient site. A skin graft is a piece of tissue that is separated completely from its origin. Thus, it has to wait for new blood vessels to grow before it can receive a supply of blood again.

What is the second stage of flap pedicle repair?

The second stage of the process is when the flap pedicle is cut permanently. This stage is performed only when the flap already receives blood from the recipient site, and thus no longer needs the blood supply from the origin site. Once the pedicle is cut, the tissue repair is complete.

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Is a tissue transfer better than a skin graft?

Thus, the cosmetic results are better than what can be achieved with a skin graft.

NCCI Policy Update

CMS explains the difference between complex repair and tissue transfer and rearrangement in Chapter 3, Surgery: Integumentary System (CPT® codes 10000-19999), section H. Repair and Tissue Transfer:

Consider Existing Policy

The CPT® code book classifies repairs (closure) (CPT® codes 12001-13160) as simple, intermediate, or complex. If closure cannot be completed by one of these procedures, adjacent tissue transfer or rearrangement (CPT® codes 14000-14350) may be utilized.

Check location and combined areas to capture separately reportable procedures

By Ken Camilleis, CPC, CPC-I, CMRS An adjacent tissue transfer (CPT ® 14000-14350) relocates a flap of healthy skin from a donor site to an adjacent laceration, scar, or other discontinuity. A portion of the flap is left intact to supply blood to the grafted area.

Include Same-location Excision, Debridement, and Repairs

Per CPT ® instructions, ATT/R procedures include excisions at the same location—for instance, to revise a scar or to remove a benign or malignant lesion. CPT® Assistant (July 2008) provides the following example: A physician excises a 1.5 cm lesion on the cheek with an excised diameter of 1.8 cm (primary defect, approximately 3.2 sq cm) and performs an adjacent tissue transfer (flap dimension of 1.4 cm x 3.0 cm, which equals a 4.2 sq cm secondary defect).

Grafts Call for Separate Coding

As CPT® Assistant (July 2008) explains, “Sometimes a tissue transfer or rearrangement procedure creates an additional defect that must be repaired.

What is CPT 14020?

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

What is advancement flap?

Advancement Flaps: An adjacent tissue transfer technique where incisions are made to create a flap that slides or “advances” forward from its normal location into a defect for repair. Here is a visual for this type of flap: Advancement Flap

How big is a defect in tissue transfer?

Once the defect being repaired with adjacent tissue transfer reaches an area of 30.1 sq cm or larger, instead of reporting the codes we have discussed above that are specific for different anatomic sites, we have special codes that are reported for “any area” larger than 30 sq cm.

What is a back cut?

From there, “back cuts” are made “all along the wound edge.” Back cuts are additional incisions made starting at the wound edge and working outward into the surrounding tissue. These incisions are often used to create flaps along the wound edge that can be brought together for repair. Therefore, the term “back cuts” might be a key word that confirms an adjacent tissue transfer since the required “additional incisions” needed to mobilize adjacent tissue for repair are met by stating that “back cuts” were made. From there, we see the surgeon designing “rotational flaps” that are then “rotated into the defect” and sutured to repair the area. This is an adjacent tissue transfer per CPT guidelines.

What is Z-plasty?

Z-plasty: An adjacent tissue transfer technique where additional incisions are made on either side of a wound creating a shape that resembles the letter Z. These additional incisions create flaps of tissue that are then sutured together to repair the wound.

What is the W-plasty technique?

W-plasty: An adjacent tissue transfer technique where additional incisions in the shape of the letter W are made along the edges of the wound to reduce tension on the edges of the wound and create some laxity in the tissue that allows the wound edges to come together to repair the wound.

What is a random island flap?

This island flap receives its blood supply from random non-dominant blood vessels in the subdermal plexus which is where the term “random” island flap comes in. The flap receives blood flow from the donor site where the flap is created and is then moved over or under other tissues to reach the defect needing repair.

Definition & Overview

• An adjacent tissue transfer, also known as a rearrangement procedure or simply ATT/R, is a medical procedure wherein flat sections of healthy skin and other tissues are transferred or transplanted to the area adjacent to a skin defect. These sections of tissue are called local flaps and are used to cover up defects or lesions on the surface of the ...

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Who Should Undergo and Expected Results

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Possible Risks and Complications