General Surgery Coding Alert

Not all code ranges follow the same rules, so read the  descriptors carefully

Selecting among the dozens of skin replacement and skin substitute codes that CPT offers can be much simpler if you know which codes refer to which popularly available skin replacement products.

Check the handy reference chart below to give yourself an advantage when reporting these procedures.

In All Cases, Consider Size and Location When reporting skin replacement or substitute procedures 15150-15176 and 15330-15431, you must consider both the area to which the surgeon placed the graft and the total area repaired, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates.

For instance: When choosing a code for acellular dermal replacement grafts (15170-15176), you must first narrow your selection by location (trunk, arms, legs -- 15170-15171; or face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits -- 15175-15176), then make your final choice according to the graft's size.

Report the primary code (either 15170 or 15175, depending on location) for grafts of 100 cm or less and an add-on code (15171 with 15170 or 15176 with 15175) for each additional 100 cm.

Example 1: The surgeon places an acellular dermal graft measuring 20 x 15 cm (300 sq cm) on the patient's left leg. In this case, you should report 15170 for the first 100 sq cm and 15171 x 2 for the additional 200 sq cm.

Example 2: The surgeon places acellular dermal allograft skin measuring 10 x 20 cm (200 sq cm) on the patient's upper right arm.

In this case, you should report 15330 (Acellular dermal allograft, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children) for the first 100 sq cm and +15331 (-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]) for the additional 100 sq cm.

Had the surgeon placed the same-size acellular dermal allograft on the patient's neck, for instance, you would instead choose 15335 (Acellular dermal allograft, 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) along with +15336 (-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]).

When NOT to Report Skin Replacement CPT makes clear that skin replacement/substitute codes 15000-15431 do not describe -simple graft application alone or application stabilized with dressings,- such as simple gauze wrap.

Instead, the replacement/substitute must be surgically anchored -using the surgeon's [...]