Skin Replacement Surgery
Skin
Replacement surgery consists of,
1)
Surgical preparation
2)
Topical placement of an,
A)
Autograft (Including tissue cultured autograft)
B) Skin substitute graft
(Homograft, allograft, Xenograft)
If
services are performed in the office – Routine dressing are not
reported separately.
Measurements apply to the size of the recipient area,
A.
Age 10 yrs or below: Percentage is applicable.
B.
Age: 10 yrs or older: Sq cm is applicable
v Procedures
involving Wrist/ankle – Use the code that includes arm or leg in the description.
v If any primary
procedures require a skin autograft or skin substitute graft for skin
closure - Use CPT 15100 – 15278 as additional procedure along
with primary procedures (Eg: Deep tumor removal)
Surgical Preparation 15002 – 15005
Initial service (Preparing a clean and viable wound surface
for placement of an autograft, flap, skin substitute graft (or) for negative
pressure wound therapy)
Don’t report 15002 – 15005 for removal
of nonviable tissue/debris in a chronic wound if the wound is left to heal
by secondary intention – Refer Debridement codes or active wound management
codes.
Code selection is based on
1)
Location
2)
Size of the defect
3)
For multiple wounds: Sum the surface area of all wounds from all anatomic
sites that are grouped together into the same code descriptor.
Eg: Surgical preparation of a 25 sq cm wound on
the scalp and a 15 sq cm wound on the face. (Totally 40 sq cm)
Ans:
15004 - for 40 sq
cm
Eg: Surgical preparation of a 75 sq cm wound on
the trunk and a 75 sq cm wound on the right thigh. (Totally 150 sq cm)
Ans: 15002
- For the first 100 sq cm
15003 - Remaining 50 sq cm
Note* If all the above four wounds did on same
day – Mod 59 with appropriate CPT code.
1) Autograft:- CPT 15040 – 15261:
— Include the harvest (15040) and/or application on an autologous skin graft.
— Repair of
donor site requiring skin graft or local flaps is coded separately.
Code selection is based on
1)
Type of autograft (Split thickness, Epidermal, Dermal, Tissue
cultured, Full-thickness Graft)
2)
Location (Hand, Feet, Trunk etc)
3)
Size of the defect.
General Information's: -
— Autograft - A graft of
tissue from one point to another of the same individual's body.
— A split-thickness
skin graft (STSG) is a skin graft including the
epidermis and part of the dermis.
— A full-thickness
skin graft (FTSG) consists of the epidermis and the entire thickness of
the dermis.
— Tissue
Cultured:
the maintenance or growth of cells in an incubator after removal from the
body. Maybe an alternative for the treatment of full-thickness wounds and
wounds that cover large areas of the body surface.
2) Skin Substitute graft:
CPT 15271 - 15278
— Non-autologous
human skin graft
— Non-human
skin substitute graft
— Biological
products for skin growth.
Don’t report skin substitute graft codes for,
Ø Application
of non-graft wound dressing (Gel, ointment, foam) (Or)
Ø Injected
skin substitutes.
General Information's: -
— Skin
substitutes are useful in providing temporary coverage of raw skin surfaces.
they usually need to be replaced later on by a split skin graft
— Autologous is derived
from part of the same individual.
— Nonautologous
is not from
same individual.
— Biological
substitute worldwide
are cadaveric skin allograft, porcine skin xenograft
and amnion.
— Porcine: A
skin graft in which pig skin is used.
— Xenograft /
Heterograft: a tissue graft or organ transplant from a donor of a different
species from the recipient.
Code selection is based on
1)
Location (Hand, Feet, Trunk etc)
2)
Size of the defect.
Less than 100 sq cm – 15271, 15272 & 15275, 15276
Greater than 100 sq cm – 15273, 15274 & 15277, 15278
For
supply of skin substitute graft, code additionally in
conjunction with CPT 15271 - 15278
General Guidelines for Graft:
For multiple wound – Sum the surface area of all wounds from all anatomic
sites that are grouped together into the same code descriptor.
(Eg: trunk and arms).
Don’t Sum wounds from different groupings of anatomic site. (Eg:
Face and arms)
Removal of current graft and/or simple cleaning of the wound is
included.
Eg: A 55 yrs old male was admitted to hospital with burns on the trunk (140
sq cm), arm (100 sq cm), neck (70 sq cm)
and face (60 sq cm), Surgical excision of the burn tissue was performed two
days ago (reported separately). Now
undergoes application of skin substitute graft on his trunk, arm, neck and face.
Ans: 15273,
+15274 x 2
15277,
+15278
Rationale: As per guidelines don’t combine different groupings
of anatomic site. But can combine all anatomic sites that are grouped together
into the same code descriptor. Hence we
are combining (Trunk and Arm = 240 sq cm) and (Neck and face = 130 sq cm).
In trunk and arm = 240 sq cm
15273
is for first 100 sq cm,
+15274 for additional 100 sq cm
+15274
for additional 40 sq cm.
In neck and face 130 sq cm
15277 is for first 100 sq cm,
+15278 for additional 30 sq cm.