Excise SCC with skin graft closure

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My doc excised a 3-cm SCC from the temporal scalp and closed the 5-cm defect with a full-thickness skin graft.

I have the CPT code as 11646, but I am not sure on the code for the skin grafting? My CPT code book says one code for the skin graft and one code for the surgical preparation...but is the surgical preparation code (15002-15005) in ADDITION to the code for the excision of the SCC?
 
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Size of lesion vs Size of graft

For an accurate response to surgical coding questions, please post the scrubbed operative note.

I do have some hints for you ...
FIRST: I'm hoping you have documentation from the physician as to the measurement of the lesion. "Excised diameter" refers to the PHYSICIAN's pre-procedure measurement of the lesion plus minimal margin necessary for complete removal. The size of the wound cannot be used as the size of the lesion; the wound may (and usually is) larger.

If all I had was what you stated: excised a 3-cm SCC from the temporal scalp - I would use 11643 for the excision.

SECOND: CPT guidelines tell us that when a primary procedure requires skin graft for closure you do NOT code 15002-15005; instead you use the primary procedure (in this case CPT 1164x).

THIRD: Read all the guidelines for grafts carefully. Do them one at a time and decide if they apply to your scenario.

FOURTH: NOTE that grafts are coded using sq cm measurements AND thickness of graft. Both these measurements/ characteristics have to be spelled out in the documentation in order to code.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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SECOND: CPT guidelines tell us that when a primary procedure requires skin graft for closure you do NOT code 15002-15005; instead you use the primary procedure (in this case CPT 1164x).

THIRD: Read all the guidelines for grafts carefully. Do them one at a time and decide if they apply to your scenario.


As always, I appreciate your help.

This is an old post, but I do have a question.

This says that CPT guidelines instruct us to not code the skin graft when used for closure, rather only code the primary procedure. I've looked through all of the CPT guidelines surrounding skin graft and excision of lesions, and I'm not finding this. Would you mind pointing me in the right direction? I guess I'm not looking in the right place.

ADDENDUM: Here is an excerpt of another skin graft he did recently (he doesn't do many, obviously):

(CPT code 11623 for the excision just performed)...Attention was turned back to the lesion on the dorsum of the hand. This wound is 4x6 cm. I took a freehand graft to a full thickness from the lateral aspect of the upper arm. The graft was sutured to the defect with interrupted sutures of 4-0 nylon that were tied over a stent type dressing using Xeroform gauze for the base layer and then wet cotton balls...

So in this scenario, there would be no additional code for this closure? In looking even at the instructions for "complex closure," it refers to "wounds requiring...stents..." Would a complex closure code even come into play instead of the skin graft?

It's just hard to believe that this would simply be coded as excision of a malignant lesion with nothing for the closure...just want to make sure I'm reading this right :)

Thanks again!
 
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In addition to the excision code, you need to add the full thickness graft cpt for scalp (4x6=24sq cm) so use 15220 (this code is up to 20 sq cm) and also use 15221 (add-on code as this is for each add'l 20 sq cm

also - make sure the excision code you select is measurement of the largest excised diameter of lesion including margins.

For example: if the actual size of lesion is 3.0 cm - but margins were 0.5mm x 2 = then your excision code selection should be for 4 cm - which would increase the code to 11624 in stead of 11623
 
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