CPT® +15777: Biologic Implant Procedures
By Ken Camilleis, CPC, CPC-I, CMRS
Add-on code +15777 Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (eg, breast, trunk) (List separately in addition to code for primary procedure) was added to the “Other Flaps and Grafts” category of the Integumentary System, Repair subheading in CPT® 2012 to describe the implantation of a biologic implant, such as donor skin or non-human skin substitute, for soft tissue reinforcement. Application of this code is fairly straightforward, but there are a few guidelines to keep in mind.
1. Distinguish Biologic Implants from Topical Applications, Mesh, and Other Materials
Code +15777 applies specifically for placement of a biologic implant (such as acellular dermal matrix) for soft tissue reinforcement or to correct a soft tissue defect (for instance, in the breast or trunk) caused by trauma or surgery. Biologic implants are usually porcine or allogenic grafts that have been decellularized to reduce the possibility of the body rejecting the implant.
Code +15777 is distinct from 15271-15278, which are intended to report topical applications of skin substitute grafts. You may report placement of biologic implant with skin graft when the procedure is done at the same operative session; however, do not report +15777 in place of 15271-15278 for topical skin substitutes.
Do not use +15777 to report placement of mesh, as described by either +49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) or +57267 Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure). Per CPT® 2012 instructions, when incisional/ventral hernia repair or repair of pelvic floor defect is involved, use +49568 or +57267, as applicable, not +15777.
Finally, for repair of anorectal fistula with plug, use 46707 Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS]), rather than +15777.
2. Know Which Primary Codes Apply
As an add-on procedure, +15777 may never be coded alone, and must always accompany an appropriate primary procedure. Generally accepted primary (and associated add-on) procedures for +15777 include autografts/allografts and skin substitute procedures of the trunk (15040-15278), as well as breast repair and reconstructions (19316-19396).
3. Append Modifier 50 for Bilateral Breast Procedures
When biologic implant is used bilaterally for tissue repair during breast reconstruction, CPT® 2012 allows you to report +15777 with modifier 50 Bilateral procedure.
4. Report Implant Supply Separately
Code +15777 describes placement of the implant only; it does not include supply of the implant. Per CPT® instructions, you may report supply of the implant separately (e.g., Q4116 AlloDerm, per sq cm). Most often, the facility (rather than the operating surgeon) will bear the cost of supplying the implant. If the surgeon does not supply the implant, he or she cannot bill for it.
Clinical Scenarios Clarify Code Application
Case 1: A 58-year-old female undergoes a unilateral total (simple) mastectomy with immediate placement of a tissue expander for reconstruction. An 81 sq cm piece of acellular dermal matrix is sutured to the subpectoral pocket rim and the skin flaps are brought together. The skin is closed primarily. Correct coding is:
19303 Mastectomy, simple, complete
19357 Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion
+15777 (for implantation of acellular dermal matrix)
Case 2: A 34-year-old woman was involved in a motor vehicle accident and suffered deep cuts to her neck from windshield glass. She required an acellular dermal allograft of a surface area totaling 167 sq cm. Correct coding is:
15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children for first 100 sq cm.
+15278 each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) for remaining 67 sq cm.
In this case, no dermal implant is used or coded; rather, topical application of skin substitute graft codes are appropriate.