CPT code 14350: Filleted finger or toe flap billing guide

Key takeaways

CPT code 14350 reports a filleted finger or toe flap, including preparation of the recipient site.

The code is technique-defined, so it sits apart from the size-based adjacent tissue transfer codes 14000 through 14302.

Place of service sets the Medicare rate, and digit modifiers FA to F9 or TA to T9 name the treated digit.

NCCI edits bundle repair codes 12001 to 13160 into 14350 for the same lesion, so modifier 59 needs a documented separate site.

Practice management software like Pabau keeps operative notes, claims, and payment status together in one patient file.

CPT code 14350 reports a filleted finger or toe flap, including preparation of the recipient site. The surgeon fillets a digit, raises its soft tissue as a flap, then moves that tissue to cover a defect close by.

Choosing the code is the easy part. Billing it is not. 14350 is technique-defined, so the square-centimeter rules that govern the rest of the 14000 series never come into play.

Three things decide whether the claim pays on the first pass: place of service, the digit modifier, and how the operative note justifies the flap. Miss any one of them and the claim comes straight back.

CPT code 14350 covers one specific flap technique

14350 is the procedure code for the filleted finger or toe flap, including preparation of the recipient site. It closes out the Adjacent Tissue Transfer or Rearrangement subsection of the AMA CPT code set, which runs from 14000 to 14350.

The descriptor is narrow on purpose. Here the surgeon harvests soft tissue from the digit itself, fillets it into a viable flap, then rotates or advances it over a nearby defect. Preparing the recipient site already sits inside the code, so no separate closure or wound bed code belongs on that claim line.

Three clinical pictures account for most 14350 claims:

• A traumatic digit injury with soft-tissue loss too wide for primary closure
• Post-amputation reconstruction that preserves usable tissue from the remaining digit
• Selected congenital digit defects that need local coverage

What separates 14350 from every other flap code is the harvest site. The donor is the finger or toe itself, not a remote patch of skin somewhere else on the body. Plastic and reconstructive surgery teams report it most, with hand and podiatric surgeons close behind.

Where 14350 sits in the adjacent tissue transfer family

Codes 14000 through 14302 are size-defined. You measure the primary defect and the secondary defect, then add them together. Pick the code that matches the total square centimeters and the body area. 14350 ignores all of that.

That one difference causes most of the upcoding and undercoding in this family. A filleted digit flap goes to 14350 whether the defect is tiny or substantial.

Hands and feet have their own size-based options in this family. A qualifying defect of 10.1 to 30 sq cm on the hand or foot goes to 14041. The same measurement on the scalp, arms, or legs goes to 14021 instead. Neither applies once the flap is a filleted digit.

14302 is an add-on and cannot stand alone, so it never pairs with 14350. Dermatology practices meet the same code family after a wide local excision, where a flap closes the defect the excision left behind.

How Medicare calculates payment for 14350

Medicare builds the allowed amount from relative value units, known as RVUs. Total RVUs get multiplied by the annual conversion factor, then adjusted for your Medicare Administrative Contractor locality. Rates move every January, so pull the current figure from the CMS Physician Fee Schedule before you quote a patient.

The three RVU components behind the allowed amount

Every CPT code carries three RVU values, and each one answers a different question about the work.

Practice expense is the component that moves. It is the reason one procedure pays two different amounts depending on where you perform it.

Place of service decides which rate you get

The POS code on the claim, not the setting in your head, selects the rate Medicare applies.

• Facility rate (POS 19, 21, 22, 23, 24): The procedure took place in a hospital, a hospital outpatient department, or an ambulatory surgery center. Practice expense RVUs drop because the facility owns the equipment and supplies. The facility then bills its overhead separately.
• Non-facility rate (POS 11, 17): The procedure took place in the office or another non-facility setting. Practice expense RVUs are higher here, so the allowed amount is higher too, because the practice absorbs every overhead cost itself.

POS errors rank among the most common reimbursement mistakes on surgical claims. Confirm where the patient was treated before the claim goes out. Geographic adjustment then moves the figure again, so a locality lookup is worth the minute it takes.

Digit modifiers matter more than RT and LT

For a digit-specific code like 14350, RT and LT do not tell the payer enough. They name a side of the body, not a digit. Medicare and most commercial plans want the HCPCS digit modifiers instead.

• Fingers: FA is the left thumb, and F1 to F4 cover the rest of the left hand. F5 is the right thumb, with F6 to F9 for the right hand.
• Toes: TA is the left great toe, and T1 to T4 cover the rest of the left foot. T5 is the right great toe, with T6 to T9 for the right foot.

Get that modifier right and the payer can see exactly which digit you treated. Here is how the rest of the modifier set behaves on this code.

Modifier policy still varies by contract, so confirm acceptance with each payer before you bill. Writing those rules down where your billers can see them beats rediscovering them one denial at a time.

ICD-10 pairings that hold up medical necessity

The diagnosis code tells the payer why a flap was necessary. If it does not point clearly to tissue loss that primary closure could not handle, expect a medical necessity denial.

Laterality runs right through this table. T87.40 leaves the extremity unspecified, while siblings such as T87.42 name the limb outright. On the foot side, L97.519 is the right, L97.529 is the left, and L97.509 is the fallback when the record does not say.

Check that every code is still valid for the current fiscal year before the claim goes out. Where the code family offers a digit specifier, use it rather than defaulting to the unspecified option.

What NCCI edits bundle into 14350

The National Correct Coding Initiative, or NCCI, treats adjacent tissue transfer as the comprehensive service for the lesion it repairs. Repair codes 12001 through 13160 fold into it for the same lesion or injury. That span reaches past simple and intermediate repair into complex repair at 13100.

Three groups of codes cause most of the bundling denials:

• Repair codes, 12001 to 13160: An intermediate repair such as 12054 bundles into the flap when it closes the same wound. Recipient site closure already sits inside the 14350 descriptor.
• Skin graft and substitute codes, 15100 to 15278: A graft over the wound the flap already covers duplicates the service. Codes like 15120 are separately reportable only when the grafting is not part of the flap code itself.
• Debridement codes, 11042 to 11047 and 97597 to 97598: Debridement performed to raise or seat the flap is bundled. A distinct wound at another site can support modifier 59, with documentation to match.

CMS refreshes the edit pairs every quarter, so a pairing that cleared in January can fail in July. Chapter 3 of the NCCI policy manual covers integumentary procedures and lists the modifier indicator for every pair.

The 90-day global period, and what falls outside it

14350 carries a 90-day global surgery period. Confirm it against the current CMS global surgery indicator file before you rely on it, because global days do get revised.

Across those 90 days, Medicare and most payers fold the following into the single surgical payment:

• Pre-operative visits on the day before and the day of surgery
• Every component of the filleted flap procedure itself
• Complications managed without a return trip to the operating room
• Post-operative follow-up visits related to the procedure
• Dressing changes and suture removal at the operative site

Plenty of legitimate work sits outside that package. Each type needs its own modifier to get paid:

• Modifier 24: an E/M visit during the global period for something unrelated to the surgery
• Modifier 58: a staged or more extensive procedure planned at the time of the first one
• Modifier 78: an unplanned return to the OR for a related complication
• Modifier 79: an unrelated procedure by the same surgeon during the global period

High-volume surgical practices lose more money in this window than anywhere else on the claim. A short monthly audit of post-operative visits catches the ones that should have carried a 24 or a 79. The CMS global surgery booklet spells out exactly what the package includes.

Documentation that keeps a 14350 claim paid

Because the code is technique-specific, the operative note has to prove the technique. A note that says “flap coverage of the digit” and stops there gives a reviewer nothing to match against 14350.

A complete 14350 operative note names:

• Pre-operative diagnosis: the specific digit injury or defect, with laterality and the digit identified
• Reason for the flap: why a filleted adjacent flap beat primary closure, a skin graft, or another repair
• Donor digit: which finger or toe supplied the tissue, how far the filleting went, and how the flap was raised
• Recipient site preparation: the debridement and preparation steps performed before inset, since they are bundled into the code
• Flap inset and closure: how the flap was secured at the recipient site and how the donor site was managed
• Post-operative diagnosis: confirmed and consistent with the pre-operative one

Build those fields into a reusable operative note template rather than trusting recall at the end of a long list. A purpose-built plastic surgery EMR can prompt for each one at the point of documentation.

Run this check before you submit

Five quick checks catch most 14350 denials before the claim ever leaves your system.

1. The POS code matches where the procedure happened, not where the surgeon usually works.
2. A finger or toe modifier is on the line, and it matches the digit named in the note.
3. No repair, graft, or debridement code from the bundled ranges is riding along for the same wound.
4. The diagnosis code carries the correct laterality and the correct seventh character.
5. The note states, in one plain sentence, why a flap beat primary closure.

Where 14350 claims usually get denied

The same five denial patterns come round again and again. Knowing them in advance beats working a denial queue after the fact.

How Pabau keeps 14350 claims and notes in one place

Reconstructive billing usually lives in three places at once. The operative note sits in the clinical system. Payer rules live in a shared document somebody updates when they remember. The remittance sits in a spreadsheet. Nobody sees the whole claim.

Practice management software like Pabau holds those pieces together. Notes, invoices, and claim records attach to the same patient file. A biller working a 14350 line can open the operative note behind it without chasing anyone. Claims management and compliance tools track what has been submitted and keep an audit trail behind it.

The payoff is fewer handoffs. Digital note templates prompt the surgeon for the flap details a 14350 claim depends on. Secure, role-based chart access supports the HIPAA documentation expectations that come with surgical records.

Keep surgical notes and claims in one place

Pabau brings operative notes, invoices, and claim records into a single patient file. Your billing team can see the documentation behind every claim line without chasing it.

Book a demo

Conclusion

14350 rewards precision in three narrow places. Report where the procedure happened, name the digit with the right modifier, and let the operative note explain why a flap was the right call.

Everything else follows from those three. A quarterly NCCI check and a monthly look at post-operative visits keep the remaining money where it belongs. Neither takes long once the habit is set.

The harder part is keeping the note, the claim, and the payment visible to the same people. Book a demo to see how Pabau keeps surgical documentation and billing in one system.

Continue your research

Billing a complete digit amputation instead? 20816 covers replantation coding, the global period, and the modifiers that go with it.

Working on a flap reconstruction claim elsewhere on the body? 19367 walks through documentation and payer rules for flap-based breast reconstruction.

Need the complex repair rules that sit next to this family? 13132 explains how complex repair is measured and when it can be reported.

Coding the excision that created the defect? 11621 sets out lesion measurement, margins, and the closure rules that follow.

Comparing systems for a surgical practice? Best plastic surgery software compares platforms built for high-complexity surgical workflows.

Frequently asked questions