Revenue Cycle Insider

Question: A patient came in with a large, non-healing wound on their lower leg. The wound measured 100 sq cm. The physician decided to perform a wound preparation, which included the removal of devitalized tissue; they then cleaned and dressed the wound. After the wound preparation, the physician applied a skin substitute graft to the wound. The graft covered the full area of 100 sq cm. This was coded as 15275, but we are getting a denial from Medicare for the claim. Is this because we are missing the surgical prep code of 15004?

AAPC Forum Participant

Answer: Yes, you are partially correct. In this scenario, the wound preparation code of 15004 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children) is necessary to prepare the wound for the application of the skin substitute graft and needs to be included on your claim.

However, when you mention the location of the damaged skin was on the lower leg, 15275 (Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area) might not be the best code choice.

You didn’t mention that the wound had anything to do with the patient’s foot, so 15273 (Application of skin substitute graft to trunk, arms, legs, 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) may be more appropriate for the work that was completed.

Laterality: Check with your individual payer to confirm if it prefers you to append laterality modifiers RT (Right side) or LT (Left side) to the procedure codes to show which side of the body was treated.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC