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14040

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🧬CPT Code 14040 — Adjacent Tissue Transfer or Rearrangement

Full Description

CPT 14040 describes the surgical repair of a skin defect located on the forehead, cheeks, chin, mouth, neck, axillae (armpits), genitalia, hands, and/or feet using a local flap of healthy, adjacent skin and underlying tissue moved from a donor site immediately next to the wound. The defect size being repaired (primary defect) combined with the area created by harvesting the donor flap (secondary defect) must total 10 square centimeters or less to qualify for this code.

This is fundamentally a reconstructive plastics technique — the surgeon designs a geometric skin flap (Z-plasty, W-plasty, V-Y advancement, rotation flap, rhomboid flap, etc.) that pivots, slides, or transposes tissue while maintaining a vascular pedicle (an attachment point that keeps blood supply intact). The donor site is closed primarily. The procedure requires precise surgical planning, geometric flap design, tissue elevation, and layered closure, reflecting its higher complexity compared to simple or even complex wound repairs.

Measurement Rule (Critical): Code selection is based on the combined area of BOTH the primary defect (the wound or excision site) AND the secondary defect (the donor area from which the flap was harvested). The excision of a lesion is included in this code and is NOT separately reportable when ATT is performed.

Anatomic Sites Covered

Site GroupExamples
Head/NeckForehead, cheeks, chin, mouth/lips, neck
Upper ExtremityHands, fingers
AxillaeBilateral armpits
GenitaliaExternal male and female genitalia
Lower ExtremityFeet, toes

Note:

Scalp, trunk, arms, and legs are not covered under 14040. See 14020 (scalp/arms/legs) and 14000 (trunk) for those anatomic regions.

Code Family / Code Tree

Adjacent Tissue Transfer or Rearrangement (14000-14350)
│
├── 14000 - Trunk; defect 10 sq cm or less
├── 14001 - Trunk; defect 10.1-30.0 sq cm
│
├── 14020 - Scalp, arms, and/or legs; defect 10 sq cm or less
├── 14021 - Scalp, arms, and/or legs; defect 10.1-30.0 sq cm
│
├── 14040 ◄ YOU ARE HERE
│            Forehead, cheeks, chin, mouth, neck, axillae,
│            genitalia, hands and/or feet; defect 10 sq cm or less
│
├── 14041 - Same sites as 14040; defect 10.1-30.0 sq cm
│
├── 14060 - Eyelids, nose, ears, and/or lips; defect 10 sq cm or less
├── 14061 - Eyelids, nose, ears, and/or lips; defect 10.1-30.0 sq cm
│
├── 14301 - Any area; defect 30.1-60.0 sq cm
└── 14302 - Any area; each additional 30 sq cm (add-on, list with 14301)

Includes (Bundled — Do NOT Bill Separately)

The following services are considered part of the work of 14040 and are not separately reportable when performed at the same site during the same operative session:

  • Excision of the lesion, wound, or scar that created the primary defect
  • Simple, intermediate, and complex closure of the primary and secondary defect wounds
  • Wound undermining, even extensive
  • Tissue elevation and mobilization of the local flap
  • Primary suture closure of the donor site
  • Routine dressing application
  • Hemostasis techniques (electrocautery, suture ligation) integral to the procedure
  • All E/M services on the day of procedure if related to the procedure (global package)
  • All post-operative visits within the 90-day global period

Excludes / Cannot Bill With (at Same Site)

Excluded CodeReason
11400-11646 (Lesion Excision)Excision is included in ATT; do not separately bill
12001-12021 (Simple Repair)Simple repair is bundled into 14040
12031-12057 (Intermediate Repair)Bundled — repair is part of the ATT work
13100-13153 (Complex Repair)Bundled — ATT includes complex closure technique
97597-97598 (Debridement)Routine wound prep is included

Exception:

If a second distinct lesion at a separate anatomic site is excised and repaired with simple closure, you may separately report the excision with Modifier -59 (Distinct Procedural Service) or XS (Separate Structure) to bypass bundling edits.

Assistant at Surgery

IndicatorValue
Medicare Assistant Surgeon PayableYes — Indicator 2
CMS Payment Rate (Physician, MD/DO)16% of the MPFS allowable
CMS Payment Rate (NP/PA/CNS)85% of the 16% MPFS amount
Applicable Modifiers-80 (MD assistant), -81 (Minimum assist), -82 (No qualified resident), -AS (PA/NP/CNS)

Remember:

Because 14040 carries an assistant-at-surgery indicator of 2, Medicare will pay for an assistant surgeon when the operative report supports the necessity of assistance. Documentation should indicate why assistance was needed (e.g., complexity of flap design, patient anatomy, concurrent procedures). Commercial payers vary — always verify individual plan policies.

wRVU and Reimbursement

ComponentNon-FacilityFacility
Work RVU (wRVU)7.437.43
Practice Expense RVU~5.77~2.72
Malpractice RVU~1.41~1.27
Total RVU~14.61~11.42
Medicare National Rate (est.)~$583~$389
Typical Commercial Rate Range1,3001,100

Note:

Medicare rates use the 2026 Conversion Factor (~$32.35). Geographic Practice Cost Indices (GPCIs) will adjust actual payment by locality. These are approximate national values.

Global Period

Modifier -54 (Surgical Care Only): Append to 14040 when billing surgeon performs the procedure only and formally transfers post-operative care to another provider.
Modifier -55 (Post-operative Care Only): Billed by the receiving provider taking over post-op care.
Modifier -58 (Staged Procedure): Use when a subsequent procedure within the 90-day global is planned and staged.
Modifier -78 (Unplanned Return to OR): For unplanned related procedures in the global period.
Modifier -79 (Unrelated Procedure): For entirely unrelated surgery during the global period.

HCC (Hierarchical Condition Category)

CPT 14040 is a procedural code and does not directly map to an HCC risk-adjustment category. HCC risk scores are driven by ICD-10-CM diagnosis codes assigned on the claim. However, the diagnosis codes reported alongside 14040 may carry HCC relevance depending on the underlying condition (e.g., skin malignancy diagnoses).

CPT 14040 itself: HCC Not Applicable.

Common ICD-10-CM Diagnosis Codes Paired with CPT 14040

The diagnosis code selected must reflect the condition that necessitated the tissue transfer — either the underlying lesion, wound, or defect.

Neoplasm / Lesion-Based

ICD-10-CMDescription
C44.01xUnspecified malignant neoplasm of skin of lip
C44.101Unspecified malignant neoplasm of skin of unspecified eyelid and periocular area
C44.201Unspecified malignant neoplasm of skin of unspecified ear and external auricular canal
C44.301Unspecified malignant neoplasm of skin of unspecified part of face
C44.401Unspecified malignant neoplasm of skin of unspecified part of scalp and neck
C44.601Unspecified malignant neoplasm of skin of unspecified upper limb, including shoulder (hands)
C44.701Unspecified malignant neoplasm of skin of unspecified lower limb, including hip (feet)
D03.xMelanoma in situ (various sites — use 4th/5th characters for specificity)
D04.xCarcinoma in situ of skin (various sites)
D23.xBenign neoplasm of skin (various sites)

Trauma / Wound

ICD-10-CMDescription
S01.01XAUnspecified open wound of scalp, initial encounter
S61.xOpen wound of wrist, hand, and fingers — use appropriate 7th character
T14.8XXAOther injury of unspecified body region, initial encounter
L90.5Scar conditions and fibrosis of skin (scar contracture)

Scar / Burn / Contracture

ICD-10-CMDescription
L90.5Scar conditions and fibrosis of skin
T23.xxxBurn of wrist and hand — appropriate encounter character
L98.499Non-pressure chronic ulcer of skin of other sites without severity specified
M79.89Other specified soft tissue disorders (when used for contracture repair)

Post-Procedure / Follow-Up Conditions

ICD-10-CMDescription
T81.31XADisruption of external operation wound, NEC, initial encounter
Z48.01Encounter for change or removal of surgical wound dressing
Z09Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

MS-DRG Applicability

CPT 14040 is an outpatient/physician-based procedure code and does not directly map to a specific MS-DRG. MS-DRGs are applied to inpatient hospital claims under the IPPS (Inpatient Prospective Payment System) and are determined by the ICD-10-PCS procedure code assigned during an inpatient admission — not by the CPT code.

However, if a patient requires inpatient admission for this type of reconstruction (e.g., complex wound following wide local excision of a malignancy), the ICD-10-PCS equivalent would be reported and the case may group to:

MS-DRGTitleNotes
573Skin graft and/or debridement for skin ulcer or cellulitis w MCCComplex wound scenarios
574Skin graft and/or debridement for skin ulcer or cellulitis w CCModerate comorbidities
575Skin graft and/or debridement for skin ulcer or cellulitis w/o CC/MCCRoutine cases
576Skin graft and/or debridement except for skin ulcer or cellulitis w MCCNon-ulcer wound repair
577Skin graft and/or debridement except for skin ulcer or cellulitis w CC
578Skin graft and/or debridement except for skin ulcer or cellulitis w/o CC/MCC

Note

Outpatient encounters using CPT 14040 in an ASC or office setting do not group to MS-DRGs.

Coding Examples

Example 1 — Basal Cell Carcinoma, Cheek

Clinical Scenario: A 68-year-old patient presents for excision of a 1.2 cm basal cell carcinoma on the right cheek. After excision with margins, the defect measures 2.0 cm x 2.5 cm (primary defect = 5.0 sq cm). The surgeon designs and elevates a rotation flap from adjacent cheek tissue; the donor area measures 2.0 cm x 2.0 cm (secondary defect = 4.0 sq cm). Combined area = 9.0 sq cm.

text
CPT:     14040 - Adjacent tissue transfer, cheek; defect ≤10 sq cm
ICD-10:  C44.311 - Basal cell carcinoma, skin of other and unspecified parts of face

Note:

The excision is NOT separately billed. The pathology specimen collection (if sent) → bill 88305 for pathology.

Example 2 — Scar Contracture, Neck (Z-Plasty)

Clinical Scenario: A patient has a burn scar contracture of the neck causing limited range of motion. Surgeon performs a Z-plasty to release the contracture. Primary defect post-excision = 3.5 sq cm. Secondary flap area = 4.5 sq cm. Total = 8.0 sq cm.

text
CPT:     14040 - Adjacent tissue transfer, neck; defect ≤10 sq cm
ICD-10:  L90.5 - Scar conditions and fibrosis of skin
         (additional code for underlying burn if relevant, e.g., T20.x sequela)

Example 3 — Squamous Cell Carcinoma, Hand (with Assistant Surgeon)

Clinical Scenario: Wide local excision of a 1.5 cm SCC on the dorsum of the hand is performed in the ASC. Post-excision, primary defect = 4.0 sq cm. An advancement flap is designed with a secondary defect of 5.5 sq cm. Combined = 9.5 sq cm. Due to proximity to tendons and the complexity of digital anatomy, an assistant surgeon was employed.

Primary Surgeon Bills:

text
CPT:     14040 - Adjacent tissue transfer, hand; defect ≤10 sq cm
ICD-10:  C44.622 - Squamous cell carcinoma of skin of right upper limb

Assistant Surgeon Bills:

text
CPT:     14040-80 (or 14040-AS if PA/NP)
ICD-10:  Same diagnosis as primary surgeon

Example 4 — Two Separate Lesions, Same Operative Session

Clinical Scenario: Patient undergoes excision and V-Y flap closure of a BCC on the right cheek (combined defect 8 sq cm, 14040 territory) AND a separate simple excision of a benign fibroma on the left arm (0.8 cm, no repair needed beyond simple closure).

text
CPT 1:   14040 - Cheek flap
CPT 2:   11401-59 - Excision benign lesion, arm, 0.6-1.0 cm (Modifier -59 for distinct site)
ICD-10 (dx 1): C44.311 - BCC, skin of face
ICD-10 (dx 2): D23.62  - Benign neoplasm of skin, right upper limb

Modifier -59 (or XS - Separate Structure) is required on the second code to bypass NCCI bundling edits.

Key Coding Pearls

  • Measure before you cut. The combined primary + secondary defect area determines the correct code — always document both measurements in the operative report.
  • ATT trumps repair. When adjacent tissue transfer is performed, do NOT separately report the closure. The excision AND the closure are bundled.
  • Pathology is always separately billable. Specimen handling (99000) and pathology interpretation (88305, 88307) are reportable separately regardless of bundling.
  • Modifier -22 (Increased Complexity): Appended when the procedure requires substantially more work than typical (e.g., severely fibrotic tissue, multiple reconstructive attempts, re-do flap surgery). Must include documentation justifying the increased effort; expect 20-30% additional reimbursement.
  • Size matters — literally. If the combined defect is 10.1 sq cm or greater at this same anatomic site, upcode to 14041. Do not round down or under-document to simplify coding.
  • Outpatient vs. Inpatient: The vast majority of 14040 cases are performed in an office, outpatient, or ASC setting. True inpatient admission is uncommon and typically indicates a more complex underlying condition.
  • NCCI Edits: CMS Correct Coding Initiative edits bundle most repair codes (12xxx, 13xxx) into 14040. Always review NCCI column 1/column 2 edits before adding additional procedure codes.

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