General Surgery Coding Alert

Question: I notice that CPT 2006 added two new codes (15000 and 15001) for site preparation in the skin grafts/replacement category. Can I use these codes prior to any skin grafting procedure?

New York Subscriber

Answer: CPT language indicates that you should report 15000 (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; first 100 sq cm or one percent of body area of infants and children) and +15001 (... each additional 100 sq cm or each additional one percent of body area of infants and children [list separately in addition to code for primary procedure]) -for initial wound recipient site preparation.-

CPT makes clear, however, 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 choice of fixation.-

In addition, you should not report site preparation 15000-15001 separately with xenograft codes 15430-15431, according to CPT instructions.

What constitutes separate preparation? -Usually, the untreated site contains uneven layers or multiple layers that pose a problem, not only facilitating the connection of the surfaces (to maximize graft survival) but accommodating the graft to cause minimal visualization of the graft site,- according to the September 1997 CPT Assistant.

If the surgeon's documentation does not meet these criteria, but he does document debridement to prepare the graft site, you should instead report the appropriate debridement code from the 11000-11044 series.

Heads up: According to CPT, free skin grafts (15000-15401) include -simple- debridement. -Simple- debridement generally means debridement of skin and/or subcutaneous tissue only. Anything more extensive qualifies for separate reimbursement.  

Example: After escharotomy (16035-16036) and debridement (16020-16030) but before placing a skin graft, the surgeon must prepare an area of 20 cm x 15 cm (300 sq cm) on a burn patient's left leg by clearing all remaining eschar, skin debris and subcutaneous tissue. In this case, report 15000 (for the first 100 sq cm) and 15001 x 2 (for the additional 200 sq cm) to describe the site preparation.