Summary & Overview
CPT 14000: Adjacent Tissue Transfer or Rearrangement, Trunk, Small Defect
CPT code 14000 is a key billing code for adjacent tissue transfer or rearrangement procedures on the trunk, specifically for defects measuring 10 square centimeters or less. This code is widely used in surgical oncology and reconstructive surgery to address skin defects resulting from trauma, surgical excision, or other medical conditions. The procedure is typically performed in office or hospital outpatient settings, making it accessible across a range of clinical environments.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for services billed under CPT 14000. Understanding the coverage policies and reimbursement benchmarks for this code is critical for providers, billing professionals, and healthcare administrators seeking to ensure compliance and optimize revenue cycle management.
This publication provides a comprehensive overview of CPT 14000, including its clinical context, typical sites of service, and payer coverage. Readers will gain insights into relevant policy updates, common billing modifiers, associated taxonomies, and related ICD-10 diagnoses. The analysis also highlights related CPT codes for larger defects and surgical site preparation, offering a broader perspective on adjacent tissue transfer procedures. The information is designed to support accurate coding, documentation, and understanding of national payer trends for this important surgical service.
CPT Code Overview
CPT 14000 describes adjacent tissue transfer or rearrangement procedures performed on the trunk for defects measuring 10 square centimeters or less. This surgical service is part of the integumentary system and is commonly used to repair skin defects resulting from trauma, surgery, or other conditions. Typical sites of service include the office (POS 11) and hospital outpatient (POS 22) settings, reflecting the flexibility of this procedure in both ambulatory and hospital environments. The code is essential for accurate billing and clinical documentation of reconstructive skin surgeries involving small defects on the trunk.
Clinical & Coding Specifications
Clinical Context
A patient presents with a small defect (10 sq cm or less) on the trunk, such as the chest, abdomen, or back, resulting from trauma, surgical excision, or wound disruption. The defect may be due to removal of a hypertrophic scar, closure of a surgical wound, or repair of a laceration. The provider, typically a surgical oncologist or general surgeon, evaluates the wound and determines that adjacent tissue transfer or rearrangement is necessary to achieve optimal closure and healing. The procedure is performed in an office or hospital outpatient setting, with careful planning to mobilize nearby skin and subcutaneous tissue to cover the defect, minimizing tension and improving cosmetic and functional outcomes.
Coding Specifications
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Modifier
59: Used to indicate a distinct procedural service, such as when the adjacent tissue transfer is performed separately from other procedures during the same encounter. -
Modifier
51: Used to denote multiple procedures performed during the same session, such as when adjacent tissue transfer is performed along with other surgical interventions.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |
51 | Multiple Procedures |
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Provider Taxonomies:
208800000X– Surgical Oncology: Represents providers specializing in surgical management of oncologic conditions, including complex wound closures and tissue transfers.
Related Diagnoses
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L90.5– Scar conditions and fibrosis of skin- Indicates the presence of scar tissue or skin fibrosis, which may require surgical intervention such as tissue transfer for improved function or appearance.
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L91.0– Hypertrophic scar- Refers to thickened, raised scars that can impair movement or cause cosmetic concerns, often treated with surgical rearrangement.
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T81.31XA– Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter- Represents a complication where a surgical wound has reopened, necessitating advanced closure techniques like adjacent tissue transfer.
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S01.81XA– Laceration without foreign body of other part of head, initial encounter- Describes a traumatic laceration, which may require tissue rearrangement if primary closure is not feasible.
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S91.301A– Unspecified open wound, right foot, initial encounter- Indicates an open wound on the foot, which may be managed with tissue transfer if direct closure is not possible.
Related CPT Codes
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14001: Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm- Used for larger defects on the trunk, when the area exceeds 10 sq cm but is less than or equal to 30 sq cm. It is an alternative to
14000for larger wounds.
- Used for larger defects on the trunk, when the area exceeds 10 sq cm but is less than or equal to 30 sq cm. It is an alternative to
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15002: Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs- Used when preparing a recipient site for grafting or tissue transfer, often performed prior to adjacent tissue transfer procedures. May be used in conjunction with
14000if both site preparation and tissue transfer are required.
- Used when preparing a recipient site for grafting or tissue transfer, often performed prior to adjacent tissue transfer procedures. May be used in conjunction with
National Reimbursement Benchmarks
For CPT code 14000, the national mean rate for Medicare is $688.24, while the BUCA (average commercial) mean rate is $724.02. Commercial payers such as UnitedHealth Group and Cigna have notably higher mean rates, with UnitedHealth Group at $986.55 and Cigna at $896.51, compared to Medicare.
Rate dispersion varies significantly across payers. Medicare shows the tightest range between the 25th and 75th percentiles ($70.00), indicating less variability in reimbursement. In contrast, UnitedHealth Group exhibits the widest dispersion ($605.83), followed by Cigna ($557.50), reflecting greater variability in commercial rates. Blue Cross Blue Shield and Aetna have moderate ranges of $299.75 and $250.00, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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