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Adjacent Tissue Transfer: An Overview & coding Guideline

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Adjacent Tissue Transfer (Rearrangement procedures) involve the transfer or transplantation of healthy, flat sections of skin or other tissue adjacent to a wound, scar or other lesion.

ATT includes moving a part of skin from one area to an adjacent area, while leaving at least one side of the flap (moved skin) intact to retain blood supply to the graft. Incisions are made, and the skin is undermined and moved over to cover the defective area, leaving connected portion intact. The flap is then sutured into place.

Uses

Patients who should undergo adjacent tissue transfer or rearrangement are those who want to cover up skin imperfections, including:

  • Scars
  • Lacerations
  • Lesions
  • Traumatic skin wounds

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. 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.

Procedure

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. 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.

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.

                              ddCoding Guidelines

Code Range :  (1400-14350)

Adjacent Tissue Transfer and Skin Replacement Procedures needed two site:-

  • Recipient site  – The area of defect that receive a graft
  • Donor Site       – The area from which healthy skin has been taken for grafting.

Adjacent Tissue Transfer:  : Types of ATT like – Z Plasty, W Plasty, V-Y Plasty.

  • First focus on Size (in Sq Cm) and Location of defect (Recipient Site).
  • Excision of lesion that is repaired by adjacent tissue transfer never code separately.
  • Simple Repair of donar site is bundled in ATT.
  • If a skin graft is required to repair the donor site then complex repair will code seperately.
  • If recipient and donar both site are required skin graft. then size of both site are added and select appropriate code for graft.

Note: Debridemen(e.g., CPT codes 11000, 11042-11047, 97597, 97598) never report with Adjacent Tissue Transfer because its first step procedure of any wound healing.

 

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