By Linda Barney, MD, katifund.org, mark Savarise, MD, MBA, katifund.org and also Jenny Jackson, MPH published February 1, 2012 • Print-Friendly

In 2012, considerable changes were made come the skin substitute codes, including the enhancement of brand-new introductory language and the creation of eight new Current Procedural hatchet (CPT)* codes that describe topical applications of skin substitute grafts (see Table 1). The 24 codes the previously explained skin substitute grafts have been deleted from the guidelines. However, codes that describe surgical ready for grafting (15002–15005) and also autografts (15040–15261) have actually not changed.

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Table 1. Brand-new skin replacement surgical treatment codes 2012


The revised skin replacement surgical treatment guidelines instruct coders on just how to correctly report codes the reference measurements of 100 sq. Centimeter or 1 percent of body area of infants and children. Once determining the involvement of body size, the measure of 100 sq cm is applicable to adults and children 10 years of age and older; percentages of body surface ar area use to infants and children younger 보다 10 year of age. The measurements apply to the dimension of the receiver area. Procedures involving the wrist and/or ankle room reported through the anatomic codes because that the arm or leg. Additionally, the graft is anchored making use of the provider’s selection of fixation, and when solutions are perform in the office, regime dressing provides are not reported separately. This codes space not intended to it is in reported because that the application of non-graft wound dressings (for example, gel, ointment, foam, liquid) or injected skin substitutes.

These codes were specifically produced for therapy of wounds in burn and trauma patients. This codes were not intended to be offered for abdominal wall fascial fix or fascial support—in various other words, underlay or overlay support.

Definitions

A new subheading referred to as “definitions” has been added that offers a much more thorough explanation of operation preparation, autografts/tissue cultured autografts, and skin substitute grafts. Surgical preparation explains the early stage services regarded preparing a clean and also viable wound surface ar for location of an autograft, flap, skin instead of graft, or for an unfavorable pressure wound therapy. Autografts/tissue-cultured autographs encompass the harvest and/or application of one autologous skin graft. Skin substitute grafts incorporate non-autologous human being skin (dermal or epidermal, cellular and also acellular) grafts (such together homograft, allograft), non-human skin instead of grafts (for example, xenograft), and biological products. Both autografts and skin substitute grafts incorporate removal of current graft and/or an easy cleansing of the wound, as soon as performed.

When a main procedure calls for an autograft or skin substitute graft for definitive skin closure (for example, radical mastectomy, deep tumor removal), report 15100–15278 in conjunction through the primary procedure.

The new CPT codes for skin substitutes incorporate a readjust in reporting based on the wound surface ar areas and anatomic locations. In years past, the codes were defined based on the first 100 sq cm and then each added 100 sq cm. CPT 2012 introduces four brand-new sets of primary and also add-on codes based on wounds “up to” 100 sq cm and wound surface “greater than or equal to” 100 sq cm. CPT proceeds to specify the codes by anatomic location. Codes 15271 and 15275 are reported because that the applications of the very first 25 sq centimeter of skin instead of grafts for total wound surface locations up to 100 sq cm. Each added 25 sq cm graft is reported with add-on password 15272 and also 15276. Password 15273 and also 15277 room reported because that the application of the very first 100 sq centimeter of skin instead of grafts for total wound surface locations greater than or same to 100 sq cm. Each added 100 sq centimeter of graft space reported through add-on codes 15274 and also 15278. Password 15273, +15274, and also 15277, +15278 are intended to explain the much more intense services for the burn patient.


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Table 2. Coding matrix for the new skin instead of graft codes


For many wounds, sum the surface ar area of all wounds inquiry grafts from the exact same anatomic site and also report the applicable main code and also add-on code in multiples, as appropriate.

Table 2 summarizes the coding matrix for the brand-new skin instead of graft codes.

Biological implants

A brand-new add-on code, 15777, Implantation of biology implant (eg, acellular dermal matrix) because that soft tissue reinforcement (eg, breast, trunk), has been established. For bilateral breast procedures, report 15777 through modifier 50. Because that implantation of fabricated mesh or other prosthesis for open incisional or ventral hernia fix or closure of a necrotizing soft tissue infection wound, report 49568 in conjunction with 49560–49566 or 11004–11006, as appropriate. Password 15777 is no to be used for the subject fixation the skin substitute graft to a wound surface, which need to be report with new codes 15271–15278.

Clinical examples

A 27-year-old male is admitted come the burn center with a 75 sq cm burn wound ~ above the appropriate thigh and also a 75 sq centimeter wound top top the left thigh. You excise the burns under to viable subcutaneous tissue and apply a skin instead of graft.

The reportable actions in this case are together follows:

15002, surgical preparation, trunk, arms, legs, very first 100 sq cm +15003, operation preparation, trunk, arms, legs, extr 100 sq cm, or component thereof 15273, Skin instead of graft, trunk, arms, legs, an initial 100 sq cm +15274, Skin instead of graft, trunk, arms, legs, added 100 sq cm, or component thereof

Both wounds room from the same anatomic location noted in the password descriptor (legs), thus, the wounds are added together for a full of 150 sq cm. Surgical ready of 150 sq cm wounds the the right and also left thighs is reported through codes 15002, first 100 sq cm, and also +15003, additional 100 sq cm, or part thereof. The applications of skin grafts to the right and also left thighs is reported with codes 15273, first 100 sq cm, and also +15274, additional 100 sq cm, or part thereof.

A mechanic was admitted to hospital v burns on both arms and hands, after his gasoline-saturated apparel was ignited from a spark. Surgical excision that the burn organization from his best hand start at the wrist was performed two days back (reported separately). He now undergoes applications of 250 sq cm of skin substitute graft top top his arms and 180 sq centimeter of skin substitute graft ~ above his hands and fingers.

The reportable actions in this case are together follows:

Arms:15273, Skin substitute graft, trunk, arms, legs, first 100 sq cm +15274, Skin substitute graft, trunk, arms, legs, extr 100 sq cm, or part thereof +15274-59, Skin substitute graft, trunk, arms, legs, extr 100 sq cm, or part thereof

Hands, fingers:15277, Skin instead of graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or many digits, an initial 100 sq cm +15278, Skin instead of graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or many digits, additional 100 sq cm, or part thereof

The arms and also hands and fingers are listed in various anatomic locations; thus, it would not be appropriate to include the wound sizes together. Procedures including the wrist and/or ankle space reported through codes that incorporate arm or leg in the descriptor. Instead, report 15273 and also 15274 for the applications of skin grafts the the arm, and also codes 15277 and 15278 for application of skin grafts of the hands and also fingers.

A 45-year-old woman is admitted come the hospital v burns on the face, ears, and feet measure a full of 225 sq cm. Operation excision that the burn tissue was performed 3 days back (reported separately). She undergoes applications of 225 sq cm of skin substitute grafts on she face, ears, and also feet.

The reportable actions in this situation are as follows:

15277, Skin instead of graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or lot of digits, very first 100 sq cm +15278, Skin instead of graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or many digits, additional 100 sq cm, or part thereof +15278, Skin substitute graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or lot of digits, additional 100 sq cm, or component thereof

The proper codes to usage for application of the very first 100 sq centimeter of skin substitute grafts for total wound surface locations greater 보다 or same to 100 sq cm, and each additional 100 sq cm, room 15277 and also 15278. The parenthetical instructions following add-on password +15276 instruct that it might only be offered in conjunction with code 15275. Therefore, it would certainly not be appropriate to report add-on code +15276 in conjunction v 15277 for the extr 25 sq cm.

A 50-year-old masculine is admitted come the hospital v a grease burn top top his appropriate arm. Girlfriend excise the burns down to viable subcutaneous tissue and apply a skin substitute graft.

The reportable measures in this case are as follows:

15002, operation preparation, trunk, arms, legs, first 100 sq cm 15273, Skin substitute graft, trunk, arms, legs, first 100 sq cm

Surgical ready of 100 sq cm wounds the the appropriate arm is reported v code 15002, very first 100 sq cm. The applications of the first 100 sq centimeter of skin substitute grafts for full wound surface areas greater 보다 or equal to 100 sq cm is reported through code 15273.

A 50-year-old female experience a unilateral full (simple) mastectomy with prompt placement that a tissue expander for reconstruction. A 75 sq cm item of acellular dermal procession is sutured come the subpectoral pocket rim prior to the skin flaps are brought together. The skin is closeup of the door primarily.

The reportable steps in this instance are as follows:

19303, Mastectomy, simple, complete 19357, chest reconstruction, immediate or delayed, with tissue expander, consisting of subsequent expansion 15777, Implantation of biology implant (eg, acellular dermal matrix) because that soft tissue reinforcement (eg, breast, trunk)

The basic unilateral mastectomy is reported with code 19303. The implantation the acellular dermal matrix is reported v 15777.

Payor worries to consider

CPT instructs the usage of comprehensive 51 on succeeding stand-alone codes. Part Medicare payors may not need the usage of this modifier, for this reason it is an important to obtain written instructions indigenous the payors for accurate claim format submission. Modifier 51 accurately identify the subsequent procedure as nonprimary and also subject come the lot of procedure payment formula.

Remember, never ever append comprehensive 51 to an add-on code since the add-on code has already been revalued for intraoperative work-related only.

Some payors may require amendment on the add-on password or might require the add-on password to be reported in units. Verify through the payors the proper format for case submission and also payment processing.

If you have extr coding questions, contact the ACS Coding Hotline in ~ 800-227-7911 between 7:00 am and also 4:00 pm hill time, excluding holidays.

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Editor’s noteAccurate coding is the obligation of the provider. This an introduction is just a source to aid in the billing process.