Skin graft to left ear with debridement prep

rgeib

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Looking for some advice on the following procedure:

Procedure note: Left ear conchal bowl debridement and reconstruction with right post auricular full thickness skin graft

Defect size / skin graft size : 1.7 x 1.8 cm left concha cavum

Informed consent was obtained. The left ear and right post auricular region were cleansed with betadine swabs. Sterile technique was used. The left ear ulceration in the concha cavum was debrided and the underlying conchal cartilage removed creating a concave defect with measurements of 1.8 x 1.7 cm. The right post auricular skin was used to harvest a full thickness skin graft to cover the defect. The graft harvest site was closed with a running locking 50 chromic suture and a compressive dressing placed. The skin graft was trimmed approproately and any subcutaneous tissue attached removed. The skin graft was placed in the defect and secured in placed with interrupted and a a running 6-0 fast gut suture. A xerform bolster dressing was placed and secured with a 2-0 prolene through and through suture. A Galsscock compressive dressing was placed. The patient tolerated the procedure well without complication. Total procedure time was 60 minutes.

I'm pretty sure the full thickness graft would be 15260, but the wound prep is a little confusing. Would this warrant 15004 for surgical preparation or is it just an extensive debridement? Any advice would be appreciated. Thanks in advance.
 

JenniferB7

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Pulling from the CPT definition of "surgical preparation" (pg 83 of 2017 CPT book):

"Surgical preparation codes 15002-15005 . . . describe the initial services related to preparing a clean and viable wound surface for placement of an autograft, flap, skin tissue graft, or for negative wound therapy. . . . appreciable nonviable tissue is removed to treat a burn, traumatic wound, or a necrotizing infection." Since the debridement and removal of cartilage was performed to prepare the ulcer site for the skin graft, which meets the requirements to bill 15004, I would code it as 15004 and 15260.

You may find these articles helpful:
https://www.aapc.com/blog/22765-surgical-preps-when-do-you-code-them/
https://vitalware.com/surgical-preparation-cpt-codes-15002-15005/

Hope that helps!
 
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