Summary & Overview
CPT 14350: Finger or Toe Fillet Flap Replacement to Restore Function
CPT code 14350 describes reconstruction using a finger or toe fillet flap to replace an affected site and restore function. This procedure is a specialized reconstructive soft-tissue surgery performed in operative settings, typically in ambulatory surgery centers or hospital operating rooms. Nationally, codes like 14350 matter because they define clinical intent for complex limb-sparing reconstructions, support documentation and coding consistency, and influence payer coverage and reimbursement practices for hand and foot salvage procedures.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-level overview of clinical context, expected sites of service, and common billing considerations. The publication outlines typical service descriptors, how this code fits within reconstructive surgical practice, and what to expect in payer reviews and authorization workflows. The content includes benchmarks and policy-relevant notes where available, clarifies scenarios for operative reporting, and highlights documentation elements that commonly accompany flap reconstruction claims. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 14350 describes the surgical replacement of an affected site using a finger or toe fillet flap to restore function at the injured location. This procedure involves reconstructive soft-tissue coverage using tissue from an adjacent digit to recreate or preserve functional anatomy.
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Service type: Reconstructive soft-tissue flap surgery
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Typical site of service: Operative setting, commonly performed in an ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old male who sustained a traumatic crush injury to the distal phalanx of the index finger with severely damaged soft tissue and exposed bone after an industrial accident. Initial management in the emergency department includes wound irrigation, tetanus prophylaxis, and radiographs. After stabilization and evaluation by hand surgery, the patient is taken to the operating room for reconstruction. The procedure 14350 (finger or toe fillet flap) is performed to replace the affected site with viable soft-tissue from an adjacent digit or toe remnant to restore coverage and preserve function. The intraoperative workflow includes debridement of nonviable tissue, designing the fillet flap based on remaining vascularized tissue, microvascular or pedicled transfer as indicated, meticulous hemostasis, layered closure, and placement of sterile dressing and splinting. Postoperative care includes analgesia, monitoring for flap viability, wound checks, hand therapy referral for range-of-motion and strengthening, and follow-up visits for suture removal and functional assessment. Typical sites of service are the hospital operating room or ambulatory surgery center. Common clinical goals are durable soft-tissue coverage, preservation of length and function, infection control, and avoidance of amputation revision procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When identical fillet flap procedures are performed on both hands or both feet during the same operative session |
52 | Reduced services | When the fillet flap procedure is partially reduced or incomplete compared with the full service described by 14350 |
53 | Discontinued procedure | When the procedure is started but terminated due to extenuating circumstances prior to completion |
54 | Surgical care only | When reporting only the surgeon’s intraoperative services and another provider reports pre/postoperative care |
55 | Postoperative management only | When the surgeon bills only for postoperative care and another provider billed the surgery |
59 | Distinct procedural service | When another distinct and separate surgical procedure is performed during the same session and needs separate reporting |
62 | Two surgeons | When two surgeons work together as primary surgeons performing separate skill sets on the same patient |
78 | Return to OR for related procedure during global period | When the patient returns to the operating room for a related procedure during the global postoperative period for 14350 |
79 | Unrelated procedure or service during global period | When an unrelated procedure is performed during the global period (note: 79 is not in the provided list; do not use) |
LT | Left side | When the procedure is performed on the left finger or toe |
RT | Right side | When the procedure is performed on the right finger or toe |
22 | Increased procedural services | When work or resources exceed typical expectations for 14350 (extensive debridement, complex reconstruction) |
26 | Professional component | If only the professional component is billed separate from technical facility resources (rare for this surgical CPT) |
59 | Distinct procedural service | (Duplicate entry avoided in table; the most clinically relevant single use is listed above) |
62 | Two surgeons | (Duplicate entry avoided in table; included above) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207P00000X | Plastic Surgery | Common specialty for complex soft-tissue reconstruction of fingers and toes |
2080P0208X | Hand Surgery (Orthopedic) | Orthopedic hand surgeons frequently perform fillet flaps for digit salvage |
207K00000X | Orthopedic Surgery | Orthopedic surgeons with hand specialty perform trauma-related reconstructions |
208100000X | General Surgery | General surgeons may be involved in peripheral soft-tissue reconstruction in some settings |
363A00000X | Podiatry | Podiatrists may perform toe fillet flaps for toe injuries or salvage procedures |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S68.121A | Laceration without foreign body of right index finger with damage to nail | Soft-tissue injuries to digits that may require fillet flap reconstruction to restore coverage and function |
S68.122A | Laceration without foreign body of left index finger with damage to nail | Same clinical relevance for left-sided digit injuries requiring reconstruction |
S68.191A | Traumatic amputation at level of right finger(s) | Fillet flap techniques can be used to salvage length and provide soft-tissue coverage in near-amputation or mangled digit scenarios |
S68.192A | Traumatic amputation at level of left finger(s) | Applicable for left-hand traumatic amputations being reconstructed with fillet flap methods |
T79.A1XA | Traumatic compartment syndrome of right upper limb, initial encounter | Compartment syndrome sequelae may necessitate reconstructive procedures including fillet flaps after ischemic injury and tissue loss |
T79.A2XA | Traumatic compartment syndrome of left upper limb, initial encounter | Left-sided correlate with similar reconstructive indications |
S98.011A | Crushing injury of right toe(s), initial encounter | Toe fillet flaps are used to reconstruct traumatic toe injuries or to utilize toe tissue for finger reconstruction |
S98.012A | Crushing injury of left toe(s), initial encounter | Left-sided toe crush injuries relevant to toe fillet flap reconstruction |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
12001 | Repair, simple, superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or less | May be used for concurrent simple skin repairs adjacent to the fillet flap donor or recipient site |
13132 | Secondary closure and complex wound repair (e.g., layered closure) of wounds 2.5 cm to 7.5 cm | May be used for complex layered closure of donor or recipient site when additional soft-tissue reconstruction is required |
13999 | Unlisted skin repair procedure | Used when no specific code describes an unusual or combined reconstructive technique performed with the fillet flap |
15734 | Muscle, myocutaneous, or fasciocutaneous flap; trunk | Not typically used for finger flaps but illustrates flap coding when larger regional flaps are required in reconstruction |
20680 | Removal of deep implant; lower extremity | May be performed if hardware exposure or infected implants are present and need removal during reconstruction |
12041 | Repair, intermediate, wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.6 cm to 7.5 cm | Used for intermediate repairs of wound edges contiguous to the fillet flap reconstruction |