Dermatology Coding Alert

You'll have more options for reporting specific types of grafts, as well as their sizes and locations

Skin graft technology has grown tremendously in recent years--and CPT is finally catching up. Next year's code manual will have 37 new skin graft codes, describing different graft types, sizes and placements.

In CPT 2006, the "Free Skin Grafts" section is renamed "Skin Replacement Surgery And Skin Substitutes," and expanded from 21 codes to 54 codes, with four codes deleted. CPT 2006 also adds a new code for skin harvesting, 15040 (Harvest of skin for tissue cultured skin autograft, 100 sq cm or less). CPT no longer considers harvesting of keratinocytes and dermal tissue for tissue-cultured skin grafts included in the autologous skin graft procedures.

The new codes are good news to Linda Martien, CPC, CPC-H, overseer of coding operations at National Healing Corporation of Boca Raton, Fla. "They have exploded the specificity for skin graft coding to a whole new level. Instead of the previous free skin graft and flap codes, we now have all of these wonderfully specific codes to use," she says. "I'm particularly pleased to see the differentiation between the layers of skin (epidermal vs. dermal) and the acellular and tissue cultured codes."

"A lot of the old codes just didn't apply," especially for dermatologists who perform wound care, says Linda Gracey, CPC, coder and medical billing supervisor for the dermatology department at Johns Hopkins University School of Medicine in Baltimore. "The addition of the new codes is really going to help a lot."

Describe Graft Type, Location With New Codes

The expansion of the skin graft CPT codes allows coders to specify what materials the dermatologist uses on specific areas of the body. The range of codes for autologous (autogenous) skin grafts, 15100-15261, now includes codes for:

• epidermal autografts--15110-15116

• dermal autografts--15130-15136

• tissue cultured epidermal autograft--15150-15157
 
• acellular dermal replacements (a.k.a. neodermis, skin substitute, AlloDerm, Dermagraft)--15170-15176.

Say Hello to New Autograft Codes

Almost all of these new codes for special grafts divide into one code for grafts of 100 cm or less and an add-on code for each additional 100 cm. They include one of these pairs of codes for trunk, arms and legs--and another pair for face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits.
 
This arrangement is similar to the current skin graft codes, Gracey says.

Example: The new epidermal autograft codes are:

• 15110--Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children

• +15111--... each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)

• 15115--Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or  multiple digits; first 100 sq cm or less, or one percent of body area of infants and children

• +15116--... each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof (list separately in addition to code for primary procedure).

CPT 2006 revises the split-graft codes (15100-15101 and 15120-15121) with the specification "split-thickness autograft." The full-thickness graft codes (15200-15261) are unchanged.

Say Goodbye to Old Allograft Codes

More new codes appear under the new "Allograft/Tissue Cultured Allogenic Skin Substitute" subhead in the "Skin Replacement Surgery and Skin Substitutes" section. Codes 15300-15321 (Allograft skin for temporary wound closure ...) and 15330-15336 (Acellular dermal allograft ...) replace the deleted allograft codes (15350-15351, Application of allograft ...).

CPT 2006 also introduces 15340-15361 (Tissue cultured allogenic skin/dermal substitute ...). The old codes for skin substitute (15342-15343, Application of bilaminate skin substitute/neodermis ...) are deleted in CPT 2006, which directs you to report 15340-15361 or 15170-15176 (Acellular dermal replacement ...) instead.

Example: A dermatologist uses AlloDerm, an acellular dermal replacement, to repair a 70-sq-cm area on an adult patient's trunk. Previously, you would report 15342 to describe the first 25 sq cm and 15343 x 2 for the remaining 45 sq cm. In 2006, report one unit of 15170.

You should also take a look at the new "Xenograft" section, with an introduction defining the procedures as "application of a non-human skin graft or biologic wound dressing (e.g., porcine tissue or pigskin) ... following debridement" of a burn, injury, infection or surgery wound.

The section consists of two revised codes and four new codes: 15400-15421 for xenografts for temporary wound closure, and 15430-15431 for acellular xenograft implants.

CPT 2006 cautions you not to report 15430-15431 in conjunction with debridement codes 11040-11042 or surgical preparation code 15000.

Employ New Botox Coding Options

You'll also see one of the three new chemodenervation codes experts expected to appear to describe Botox injections for hyperhidrosis (see "3 New Codes May Increase Your Hyperhidrosis Treatment Options in 2006" in the October 2005 Dermatology Coding Alert). CPT 2006 includes these new codes in the "Sympathetic Nerves" subsection under the "Destruction by Neurolytic Agent" heading:

• 64650--Chemodenervation of eccrine glands; both axillae

• 64653--...other area(s) (e.g., scalp, face, neck), per day.

Although some experts expected that CPT 2006 would introduce new codes for chemodenervation of eccrine glands in the extremities, there is still no specific CPT code for Botox injections to the hands and feet. However, a note under the two new codes reads, "For chemodenervation of extremities (e.g., hands or feet), use 64999."

Another note directs coders to "report the specific service in conjunction with code(s) for the specific substance(s) or drug(s) provided." The HCPCS code for Botox supply is J0585 (Botulinum toxin type A, per unit).