General Surgery Coding Alert

Anatomic location is now a factor for graft preparation

CPT 2007 brings you four new codes for surgical skin preparation, which will allow for more precise identification of the procedures your surgeon performs -- and which might result in more equitable payments as well.

Out with the old: Previously, CPT listed two codes to identify surgical preparation or creation of a graft recipient site by excision (15000 for the first 100 sq cm or 1 percent of the body area of infants and children, and +15001 for each additional 100 sq cm or 1 percent of body area of infants and children).

In with the new: CPT 2007 deletes 15000 and 15001 and replaces them with the following:

- 15002 -- 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, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children

- +15003 -- - each additional 100 sq cm or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure)

- 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

- +15005 -- - each additional 100 sq cm or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure).

-I think this is a positive development,- says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates. -The skin graft and replacement codes are themselves divided according to anatomic area, primarily because the face, scalp, eyelids, hands and so on require more work and a greater level of precision than the chest or back or thigh, for instance. As a result, codes describing grafts to the face and other delicate areas reimburse at a greater rate than those describing grafts to the trunk, arms and legs.-

The good news: Although Medicare has not yet released the 2007 physician fee schedule, Bishop predicts that 15004 and 15005 (which describe site preparation for the delicate areas of face, scalp, etc.) will likewise reimburse better than 15002-15003 (which describe preparation of the trunk, arms or legs).

In any case, 15002-15005 will better describe the work the surgeon performs than the previous codes (15000-15001), which did not differentiate by location.

Claim Preparation in Addition to Graft Procedures

Aside from the better anatomic specificity that 15002-15005 afford, you-ll apply these codes in much the same fashion as the previous preparation codes 15000-15001, says Terri Brame, CPC, CPC-H, operations manager for the division of clinical revenue at the University of Washington department of surgery.

Specifically, CPT 2007 instructs, -Codes 15002-15005 describe burn and wound preparation or incisional or excision release of scar contracture resulting in an open wound requiring a skin graft- -- which is the same description previous CPT versions have given 15000-15001. Also, CPT specifies that you should report 15002-15005 -with code for appropriate skin grafts or replacements (15050-15261, 15330-15336)- whether the surgeon applies the skin graft immediately following the site preparation or at a later time.

In short: You will always report skin preparation separately, when performed, with skin graft or replacement procedures 15050-15261 and 15330-15336.

CPT also states that you may report 15002-15005 along with 15300-15321 and 15360-15366 for excision with immediate skin grafting, or with 15400-15421 for immediate xenogeneic dermis placement.

Don't overcode: You should not report any grafting procedure (15040-15431) in addition to 15002-15005 if the surgeon applies a dressing only to the recipient site, CPT instructs.

Keep Add-ons With the Parent Code

You should apply 15003 with 15002 only. Likewiseyou must report 15005, when appropriate, only in addition to 15004. Neither 15003 nor 15005 can -stand alone.-

Example: The surgeon surgically prepares a graft site measuring 295 sq cm on the patient's upper back. He then applies a tissue-cultured allogeneic dermal substitute to the surface.

In this case, report 15002 for the first 100 sq cm and 15003 x 2 for the additional 195 sq cm.

You will also report 15360 (Tissue cultured allogeneic dermal substitute, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children) for the first 100 sq cm of skin substitute and +15361 x 2 (- each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof [list separately in addition to code for primary procedure]) for the remaining 195 sq cm of skin substitute.

Site Preparation and Lesion Excision Differ

If the surgeon performs a lesion excision, you should report 11400-11471 (for benign lesions) or 11600-11646 (for malignant lesions) rather than site preparation codes 15002-15005.

-Codes 15002-15005 describe excision of open wounds, burn eschar or scar, or incisional release of scar contracture -- not lesion excision,- Brame says.

Tip: A surgeon will generally follow lesion excision with wound repair (12001-13160) or even adjacent tissue transfer (14000-14350), while site preparation commonly (but not always) precedes skin graft and replacement procedures (15040-15431), as described above.