How To Use CPT Code 15630

CPT code 15630 describes the procedure of delaying a flap or sectioning of a flap at the eyelids, nose, ears, or lips. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 15630?

CPT 15630 is a code used to describe the delay of a flap or sectioning of a flap at the eyelids, nose, ears, or lips. This procedure involves dividing a previously created pedicled flap from its base and completing the inset of the graft at the recipient site. The provider also repairs the remaining wound where the flap was pedicled.

2. Official Description

The official description of CPT code 15630 is: ‘Delay of flap or sectioning of flap (division and inset) at eyelids, nose, ears, or lips.’

3. Procedure

The procedure for CPT 15630 involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider divides a previously created pedicled flap from its base at the donor site.
3. The remnant portion of the flap base is sutured back to the donor site.
4. The provider completes the inset of the graft at the recipient site of the eyelids, nose, ears, or lips.
5. Both the donor and recipient sites are closed in layers.

4. Qualifying circumstances

CPT 15630 is performed when there is a need to delay a flap or section a flap at the eyelids, nose, ears, or lips. This procedure is typically done as a staged or planned second surgery during the 90-day global period of the initial skin graft procedure. It is important to note that if a skin graft or flap is necessary to close the donor site after division of the pedicle, that procedure may be reported separately.

5. When to use CPT code 15630

CPT code 15630 should be used when a provider performs the delay of a flap or sectioning of a flap at the eyelids, nose, ears, or lips. It is important to ensure that the procedure is performed during the appropriate global period and that the documentation supports the need for this specific procedure.

6. Documentation requirements

To support a claim for CPT 15630, the provider must document the following information:

• Reason for performing the delay of flap or sectioning of flap procedure
• Details of the procedure, including the specific sites involved (eyelids, nose, ears, or lips)
• Date of the procedure
• Start and end time of the procedure
• Details of the closure of both the donor and recipient sites
• Use of modifier 58, Staged or related procedure or service by the same physician, when applicable

7. Billing guidelines

When billing for CPT 15630, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Modifier 58 should be added when reporting this procedure during the global period of the initial skin graft procedure. It is also important to note that a separate skin graft or flap procedure may be reported if necessary to close the donor site after division of the pedicle.

8. Historical information

CPT 15630 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a delay of flap procedure at the eyelids to prepare for a subsequent reconstructive surgery.
2. A provider performs sectioning of a flap at the nose to improve the aesthetic outcome of a previous procedure.
3. A patient undergoes a delay of flap procedure at the ears to allow for better blood supply and healing before a reconstructive surgery.
4. A provider performs sectioning of a flap at the lips to address a defect and improve functionality.
5. A patient undergoes a delay of flap procedure at the eyelids to ensure optimal tissue viability for a subsequent reconstructive surgery.
6. A provider performs sectioning of a flap at the nose to address a complex defect and achieve better cosmetic results.
7. A patient undergoes a delay of flap procedure at the ears to improve the success rate of a subsequent reconstructive surgery.
8. A provider performs sectioning of a flap at the lips to address a functional impairment and improve the patient’s quality of life.
9. A patient undergoes a delay of flap procedure at the eyelids to allow for better tissue healing and minimize complications in a subsequent reconstructive surgery.
10. A provider performs sectioning of a flap at the nose to optimize the aesthetic outcome and improve patient satisfaction.