September 19, 2019
Someone told me we can bill CPT 23395 (Muscle transfer, any type, shoulder or upper arm; single) when I do a DIEP flap. I checked it out with our compliance department and they said there are no Medicare bundling edits between the two codes so it should be alright. I thought I better check it out with you though.
Gosh, I never would have thought to use 23395 with the DIEP flap code (19364 or S2068). In fact, in my many years of coding consulting for plastic surgeons I had never even encountered that code so I looked it up.
CPT’s vignette for 23395 states the typical patient is “a 35-year-old patient with scapular disability and pain caused by scapular winging undergoes pectoralis major transfer.” This doesn’t sound like a procedure performed for breast reconstruction. So even though there are no National Correct Coding Initiative (NCCI) edits between the two codes, 23395 and 19364, we cannot recommend reporting 23395 with the DIEP flap code.
*This response is based on the best information available as of 09/19/19.