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Delay of flap is a surgical technique that involves a staged division of a flap to improve its blood supply, which is crucial for successful healing and integration at the recipient site. This procedure is particularly important in reconstructive surgery, where adequate vascularization is necessary to ensure that the tissue remains viable after being transferred from one area of the body to another. The term "sectioning of flap" refers to the complete division of the flap, followed by its inset at the designated recipient site. In the context of this procedure, a delay maneuver may be performed, which entails partially dividing the pedicle of the flap. This action is intended to enhance the circulation to the flap, thereby promoting better healing outcomes. Once the flap is sectioned, the surgeon will transect it and proceed to inset it into the defect at the recipient site, ensuring that it is properly positioned for optimal healing. Any portion of the flap that is not utilized during this process is typically returned to the donor site. In cases where the donor site has been previously closed with a skin graft, the graft may need to be removed and replaced with the remaining flap tissue. If additional coverage is necessary at the donor site, the surgeon may opt to apply a separately reportable skin graft or a local flap to ensure adequate closure and healing. The specific CPT® code for the delay or sectioning of a flap to the trunk is 15600, while other codes are designated for different anatomical locations, such as the scalp, arms, legs, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet, eyelids, nose, ears, or lips.
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The delay of flap or sectioning of flap procedure is indicated for various conditions where tissue reconstruction is necessary. The following are the explicitly provided indications for this procedure:
The procedure for delay of flap or sectioning of flap involves several critical steps, each aimed at ensuring the successful transfer and integration of tissue. The following procedural steps are outlined:
Post-procedure care is essential for ensuring proper healing and minimizing complications. After the delay of flap or sectioning of flap procedure, the patient will typically be monitored for any signs of complications, such as infection or flap failure. The surgical sites, both donor and recipient, will require appropriate dressing and care to promote healing. Patients may be advised on activity restrictions to avoid strain on the surgical sites. Follow-up appointments will be necessary to assess the healing process and to manage any additional interventions that may be required for optimal recovery.
| Short Descr | DELAY FLAP TRUNK | Medium Descr | DELAY FLAP/SECTIONING FLAP TRUNK | Long Descr | Delay of flap or sectioning of flap (division and inset); at trunk | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5A - Ambulatory procedures - skin | MUE | 2 | CCS Clinical Classification | 172 - Skin graft |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |
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