While we’ve already discussed general flap coding updates in the past, there are certain types that deserve more individualized attention. In particular, deep inferior epigastric perforators, more commonly known as DIEP flaps, require a closer look, as their coding requirements are tricky and, in many ways, sorely outdated.

According to guidance published by the American Medical Association (AMA) back in 2011, CPT code 19364 (Breast reconstruction with free flap) is the proper way to designate DIEP flaps for reconstruction after breast surgery. They even go so far as to say that 19364 is “the appropriate code to report free flap breast reconstruction, regardless of the specific free flap used. It may be a free transverse rectus abdominis myocutaneous (TRAM), a free DIEP, or a gluteal free flap.” In other words, AMA intended 19364 to be a sort of catch-all code that doesn’t look any deeper into the exact type of flap.

But as all coders know, lack of specificity is rarely a good idea. Given that so many practices and facilities disagreed with the above advice (which has not been updated since its 2011 publication), many opted to instead report DIEP flaps with HCPCS Level II code S2068 (Breast reconstruction with deep inferior epigastric perforator (DIEP) flap or superficial inferior epigastric artery (SIEA) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral). Not only is this code significantly more detailed, but it even mentions DIEP flaps by name, making it a seemingly simple choice for reporting this procedure properly.

Despite AMA’s guidance, many practices report that S2068 is their go-to DIEP code when not submitting to Medicare. As a general rule, pretty much every other major insurance provider prefers the specificity of this HCPCS code, so unless they specifically forbid it, using S2068 in place of 19364 has become the de facto best practice whenever possible.