General Surgery Coding Alert

Question: The patient sliced the tip of his finger trying to catch a piece of falling metal. Examination revealed a 1.0-cm square avulsion injury to the radial aspect of the index finger down to subcutaneous tissue. There was no bone involvement or exposure, and no nail involvement. The patient wanted the skin replaced as a graft.

The surgeon performed digital block and additional preparation, then sutured the patient's own skin, from the finger, back in place.

The surgeon wants to code this as a full-thickness free graft, while I think this is wound repair. Who's right?

Michigan Subscriber Answer: From the information you provide, you are correct to want to report wound repair -- probably complex repair, such as 13131 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm) -- for this procedure.

A free skin graft (for example, 15240, Full-thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 20 sq cm or less) includes both suturing the donor skin to the graft location and direct closure of the donor site. In this case, there is no -donor site.- The surgeon is merely re-attaching skin by suture to the area from which it was lost.

CPT instructions preceding the graft codes expressly state, -These codes are not intended to be reported for simple graft application alone or application stabilized with dressings -- Further, CPT also specifies that complex repair -includes the repair of wounds requiring more than layered closure,- including -retention sutures.-