Otolaryngology Coding Alert

Give yourself a Grafting 101 review Otolaryngology Coding Alert's "Excision Requires Full-Thickness Skin Graft" caused numerous otolaryngology coders to ask about graft coding. If you're unsure about what a full-thickness graft includes, try this mini-quiz:
 
1. Fill in the blank: Graft codes, such as 15260 (Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less), don't include donor site repair requiring __________.
 
2. True or false: The correct anatomic location of a preauricular crease is the ear.
 
3. Complete the statement: You should report 15000 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar [including subcutaneous tissues]; first 100 sq cm or one percent of body area of infants and children):
 
 a. when your otolaryngologist debrides a recipient site that he created during the same surgical session
 b. whenever you report a graft code, such as 15260 (Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less)
 c. when your otolaryngologist debrides intact skin
 d. appended with modifier -51 (Multiple procedures)
 e. never.

1. Separately Report Graft, Flap Donor Site Repair Answer: Graft codes don't include donor site repair requiring skin graft or local flaps.

But when answering Otolaryngology Coding Alert's November 2003 "You Be the Coder" about nasal cancer excision and reconstruction, some otolaryngology coders also assigned 12052-51 (12052, Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) to cover the closure of the "deep defect." They based their coding on CPT's free skin grafts notes that state, "repair of a donor site requiring skin grafts or local flaps is to be added as an additional procedure." The note prompted them to ask why the answer didn't include 12052-51.
 
Here's why: CPT's note actually instructs you to separately report donor site repairs that require a flap or graft, says Stephen Sussman, MD, an otolaryngologist with Maui Medical Group in Wailuku, Hawaii. In "Excision Requires Full-Thickness Skin Graft," the surgeon uses a full-thickness skin graft to close the 3-cm nasal tip defect. Since the example doesn't mention that the otolaryngologist uses a graft or flap to close the preauricular crease donor site, he presumably closes the donor site with an intermediate repair (12052, Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm).
 
The graft code (15260) includes "direct closure of donor site," meaning simple (superficial), intermediate (layered closure), and complex (more than layered closure) repair. If, however, the donor site requires a skin graft, for instance a split graft (15120, Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first [...]