Medicine and Surgery Section - Wisconsin.gov
Medicine and Surgery Section - Wisconsin.gov
Medicine and Surgery Section - Wisconsin.gov
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Category<br />
Integumentary System<br />
(Continued)<br />
Appendix 15<br />
(Continued)<br />
Proc.<br />
Code<br />
Description<br />
15782 regional, other than face<br />
15783 superficial, any site (eg, tattoo removal)<br />
15820 Blepharoplasty, lower eyelid;<br />
15821 with extensive herniated fat pad<br />
15822 Blepharoplasty, upper eyelid;<br />
15823 with excessive skin weighting down lid<br />
15824 Rhytidectomy; forehead<br />
15825 neck with platysmal tightening (platysmal flap, P-flap)<br />
15826 glabellar frown lines<br />
15828 cheek, chin, <strong>and</strong> neck<br />
15829 superficial musculoaponeurotic system (SMAS) flap<br />
15831 Excision, excessive skin <strong>and</strong> subcutaneous tissue (including lipectomy);<br />
abdomen (abdominoplasty)<br />
15832 thigh<br />
15833 leg<br />
15834 hip<br />
15835 buttock<br />
15836 arm<br />
15837 forearm or h<strong>and</strong><br />
15838 submental fat pad<br />
15839 other area<br />
19140 Mastectomy for gynecomastia<br />
19316** Mastopexy<br />
19318** Reduction mammaplasty<br />
19324** Mammaplasty, augmentation; without prosthetic implant<br />
19325** with prosthetic implant<br />
19340** Immediate insertion of breast prosthesis following mastopexy,<br />
mastectomy or in reconstruction<br />
19342** Delayed insertion of breast prosthesis following mastopexy, mastectomy<br />
or in reconstruction<br />
19350** Nipple/areola reconstruction<br />
19357** Breast reconstruction, immediate or delayed, with tissue exp<strong>and</strong>er,<br />
including subsequent expansion<br />
19361** Breast reconstruction with latissimus dorsi flap, with or without prosthetic<br />
implant<br />
19364** Breast reconstruction with free flap<br />
19366** Breast reconstruction with other technique<br />
19367** Breast reconstruction with transverse rectus abdominis myocutaneous<br />
flap (TRAM), single pedicle, including closure of donor site;<br />
19368** with microvascular anastomosis (supercharging)<br />
19369** Breast reconstruction with transverse rectus abdominis myocutaneous<br />
flap (TRAM), double pedicle, including closure of donor site<br />
19380** Revision of reconstructed breast<br />
19396** Preparation of moulage for custom breast implant<br />
**Does not require PA if diagnosis is breast cancer (International Classification of Diseases, Ninth Revision, Clinical Modification<br />
diagnosis codes 174.0-174.9, 175.0-175.9, 233.0, 238.3, 239.3).<br />
Physician Services H<strong>and</strong>book — <strong>Medicine</strong> <strong>and</strong> <strong>Surgery</strong> December 2005 113<br />
Appendix