General Surgery Coding Alert

Question: Our surgeon excised a 4.5 cm melanoma with a 2.5 cm margin from a patient’s left arm. The surgeon then applied a 40 sq cm skin substitute graft with sutures, and dressed the area. Should we code this as 15271 and +15272 based on the graft size?

Iowa Subscriber

Answer: No, you should not report these graft codes based on the graft size, but instead, you should base your code selection on the wound size. In this case, you should report 15271 (Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area) and two units of +15272 (Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof [List separately in addition to code for primary procedure]).

The graft size in this case is only 40 sq cm. But the wound size has a diameter of 9.5 cm, which means an area of about 71 sq cm. For that reason, you should code 15271 for the first 25 cm, +15272 for the next 25 cm, and +15272 for the remaining 21 sq cm.

Remember: The size of the graft has nothing to do with the code selection for skin substitute grafts. Wound surface area and location on the body is all that matters. Therefore, if you had erroneously based the code on the graft size rather than the wound size, you would have sacrificed an additional payment amount of $27.63 for the additional unit of +15272 (Medicare Physician Fee Schedule non-facility national limit amount, conversion factor 35.8887.