General Surgery Coding Alert

Not all code ranges follow the same rules, so read the  descriptors carefully

Selecting among the dozens of skin replacement and skin substitute codes that CPT offers can be much simpler if you know which codes refer to which popularly available skin replacement products.

Check the handy reference chart below to give yourself an advantage when reporting these procedures.

In All Cases, Consider Size and Location

When reporting skin replacement or substitute procedures 15150-15176 and 15330-15431, you must consider both the area to which the surgeon placed the graft and the total area repaired, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates.

For instance: When choosing a code for acellular dermal replacement grafts (15170-15176), you must first narrow your selection by location (trunk, arms, legs -- 15170-15171; or face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits -- 15175-15176), then make your final choice according to the graft's size.

Report the primary code (either 15170 or 15175, depending on location) for grafts of 100 cm or less and an add-on code (15171 with 15170 or 15176 with 15175) for each additional 100 cm.

Example 1: The surgeon places an acellular dermal graft measuring 20 x 15 cm (300 sq cm) on the patient's left leg. In this case, you should report 15170 for the first 100 sq cm and 15171 x 2 for the additional 200 sq cm.

Example 2: The surgeon places acellular dermal allograft skin measuring 10 x 20 cm (200 sq cm) on the patient's upper right arm.

In this case, you should report 15330 (Acellular dermal allograft, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children) for the first 100 sq cm and +15331 (-each additional 100 sq cm or each additional one percent of body area of infants and children, or part thereof [list separately in addition to code for primary procedure]) for the additional 100 sq cm.

Had the surgeon placed the same-size acellular dermal allograft on the patient's neck, for instance, you would instead choose 15335 (Acellular dermal allograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children) along with +15336 (-each additional 100 sq cm or each additional one percent of body area of infants and children, or part thereof [list separately in addition to code for primary procedure]).

When NOT to Report Skin Replacement

CPT makes clear that skin replacement/substitute codes 15000-15431 do not describe -simple graft application alone or application stabilized with dressings,- such as simple gauze wrap.

Instead, the replacement/substitute must be surgically anchored -using the surgeon's choice of fixation.-

In addition, you would not report routine dressing supplies or changes separately using codes in the 15000-15431 range.

For Autograft, Consider Graft Depth in Addition

Autografts (skin from the patient's own body) comprise the code range 15100-15157 and include the following subsections:

- split-thickness autografts -- 15100-15101 and 15120-15121

- epidermal autografts -- 15110-15116

- dermal autografts -- 15130-15136

- tissue cultured epidermal autograft -- 15150-15157 (included in the chart).

Pay special attention to the graft size for 15150-15157 because the descriptors differ markedly from those for other skin graft codes.

For instance, the descriptor for 15150 specifies, -first 25 sq cm,- while add-on code 15151 specifies -additional 1 sq cm to 75 sq cm,- and 15152 describes -each additional 100 sq cm.- You should only report 15150 and 15151 once per session.

Example: For a graft of 200 sq cm, you would report 15150 (for the first 25 sq cm), 15151 (for the next 75 sq cm) and 15152 (for the final 100 sq cm).

When reporting these codes, you must first determine the graft's type and/or depth (split-thickness, epidermal, dermal or tissue cultured epidermal) to narrow your selection, Bishop says.

Next, you should determine the location of the graft.

For instance, CPT further divides split thickness grafts by -trunk, arms, legs- (15100-15101) and -face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits- (15120-15121). Other autografts follow the same or similar guidelines.

Finally, you should measure the total area grafted.

Example: For a split-thickness autograft of the face and neck, you would report 15120 (Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children [except 15050]) for the first 100 sq cm (or one percent of body area for infants and children) and +15121 (- each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof [list separately in addition to code for primary procedure]) for each additional 100 sq cm the surgeon repairs.

Therefore, for a split-thickness autograft of the face and neck measuring 17 cm x 17 cm (289 sq cm), you would report 15120 (for the first 100 sq cm) and 15121 x 2 (for the additional 189 sq cm).

Measuring tip: To ensure accurate measurements, encourage your surgeon to keep a sterile flexible ruler in the OR to measure the actual surface size of the wound.

Autograft Harvesting Has Its Own Code

Keep in mind that you should report harvesting of keratinocytes (full-thickness biopsy) and dermal tissue for tissue-cultured skin grafts, when performed, says Terri Brame, CPC, CPC-H, operations manager for the Division of Clinical Revenue at the University of Washington department of surgery.

The appropriate code for harvesting cultured skin autograft is 15040 (Harvest of skin for tissue cultured skin autograft, 100 sq cm or less).