If you are working in a specialty where you find yourself coding fat or fascia grafts regularly, you might be asking yourself “What happened to CPT 20926?”
Prior to 1/1/2020, CPT 20926 was used for transfer of tissue from one part of the body to another when we did not have a more specific code for that graft in CPT. This left coders and physicians using CPT 20926 to represent many different types of services – anything from liposuction to obtain some fat that was injected into the breast as part of a reconstruction to surgically excising a layer of temporal fascia which was inserted to repair the ear drum in a tympanoplasty procedure. The AMA reviewed CPT 20926 and its various uses last year and realized that this code was representing many different procedures all involving various anatomic sites and different amounts of clinical work to harvest the graft. As a result, they determined that the different types of grafts being reported with CPT 20926 should be better defined.
As of 1/1/20, CPT 20926 has been deleted. While you might be tempted to look for it’s replacement in the same section of CPT, the AMA has actually added 5 new codes to the Integumentary Section of the CPT manual (. The codes are distinguished by the method of obtaining the graft (direct excision vs. liposuction), the anatomic site where the graft is placed, and the amount of fat injected when applicable for the type of graft. Here is an overview of the new codes:
- CPT 15769: Grafting of autologous soft tissue, other, harvested by direct excision (e.g., fat, dermis, fascia)
- CPT 15771: Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms and/or legs; 50 cc or less of injectate
- + CPT 15772: Each additional 50 cc or part thereof (list separately in addition to code for primary procedure)
- CPT 15773: Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands and/or feet; 25 cc or less of injectate
+ CPT 15774: Each additional 25 cc or part thereof (list separately in addition to code for primary procedure)
As you can see, CPT 15769 is coded for “any autologous graft” (such as fat, fascia, etc.) where the graft is taken from the donor site by direct incision. The term autologous means “from the patient’s own body” so this type of graft is taken from one site in a patient’s body and implanted in another. Direct excision as the name implies, means they are making an incision and excising a piece/sheet of tissue. To give an example, that temporalis fascia graft for a tympanoplasty when harvested through a separate incision would be coded with CPT 15769 for “direct excision.”
In contrast, if autologous fat is harvested by liposuction technique (where a needle is inserted and fat cells withdrawn and prepared for injection in another site in the body), you need to look at codes 15771-15774. To pick the right code(s), you first need to identify the recipient site (where the graft is going). The anatomic sites listed in the code descriptions are recipient sites not donor sites (where the graft came from). You then need to determine how many cc’s of fat are being injected.
- If fat is injected into more than one anatomic site, but those recipient sites are listed under the same code (e.g., breast and scalp), add the total cc’s injected into all sites together to start coding.
- If fat is injected into more than one anatomic site, but those sites fall under different codes (e.g., breast and lips), add the total cc’s for the sites under the same code description together and add the total cc’s for the sites under a different code description together and assign separate codes.
- Notice the terminology “or part thereof” in the add on codes. That means that the total amount of cc’s injected does not need to be equally divided by 50 or 25 – you can assign an additional unit of 15772 or 15774 once the total cc’s of fat injected exceed 50 or 25 cc in total respectively.
Example #1: Fat is harvested from the abdomen by liposuction technique. The fat cells are prepared for injection. 150 cc are injected into the right breast, 30 cc into the left breast, and 80 cc into the left forearm.
Answer example #1: Since the breast and the arm are both recipient sites listed in codes 15771/15772, we will add the amount of fat injected at all sites together to start coding. So 150+30+80 = 260 cc in total. From there, we will report CPT 15771 x1 for the first 50 cc. We will then subtract 50 from 260, and we will have 210 cc left to report. This would be coded with CPT 15772 x 5. Again we are coding 1 unit of 15772 for “each additional 50 cc or part thereof.” 50+50+50+50 is 200 cc which is the first 4 units of 15772, and then we have a “part thereof” – 10 cc- leftover. We add the 5th unit of 15772, and our final coding is 15771 x1 and 15772 x5.
Example #2: Fat is harvested from the abdomen by liposuction technique. The fat cells are prepared for injection. 100 cc are injected into the left breast, 60 cc into the scalp, and 30 cc into the lips and 20 cc into the eyelids.
Answer example #2: Since the breast and the scalp are both recipient sites listed in codes 15771/15772, we will add the amount of fat injected at those sites together to start coding. So 100+60 = 160 cc in total. The lips and the eyelids are both recipient sites listed in codes 15773/15774 so we will add the amount of fat injected into those sites together. So 30+20 = 50 cc in total. Our 160 cc and 50 cc will not be added together since these recipient sites fall under different codes. From there, we will report CPT 15771 x1 for the first 50 cc of fat injected into the breast/scalp. We will then subtract 50 from 160 and have 110 cc left to report. This would be coded with CPT 15772 x 3. Again we are coding 1 unit of 15772 for “each additional 50 cc or part thereof.” We will then report 15773 x1 for the first 25 cc of fat injected into the lips/eyelids. We will subtract 25 from 50 and have 25 cc left to report. This will be coded with 15774 x1 for “each additional 25 cc or part thereof.”
Final coding: 15771 x1, 15772 x3, 15773 x1, 15774 x1
