Q&A: Reporting TRAM procedures in ICD-10-PCS

Q: Considering the fiscal year 2019 update to the ICD-10-PCS Official Guidelines for Coding and Reporting for Transfer procedures, how should we now report a pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure in ICD-10-PCS?

A: A TRAM procedure (a post-mastectomy reconstruction) is when the physician takes the rectus abdominis muscle and carries that skin and fat to the chest wall, creating a shape with the tissue. In order to Transfer the flap to the chest, the muscle is tunneled under the upper abdominal skin.

In the ICD-10-PCS alphabetic index, there is a main entry for “TRAM,” which then gives you the option for “free” or “pedicled.” Although the 2019 ICD-10-PCS Official Guidelines for Coding and Reporting update says to code to the deepest layer of tissue, it doesn’t necessarily change how this procedure is reported since we’re still using ICD-10-PCS table 0KX for these Transfer procedures. 

Some of the ICD-10-PCS codes for this procedure include:

• 0KXK0Z6, Transfer of the right abdomen muscle, transverse rectus abdominis myocutaneous flap, open approach
• 0KXK4Z6, Transfer of the right abdomen muscle, transverse rectus abdominis myocutaneous flap, percutaneous endoscopic approach
• 0KXL0Z6, Transfer of the left abdomen muscle, transverse rectus abdominis myocutaneous flap, open approach
• 0KXL4Z6, Transfer of the left abdomen muscle, transverse rectus abdominis myocutaneous flap, percutaneous endoscopic approach

Editor’s note: Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, regulatory specialist for HCPro in Middleton, Massachusetts, answered this question.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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