Inpatient Facility Coding & Compliance Alert

Plus: Keep this list of services included with skin substitute grafts. 

The provider excises a 3-cm melanoma with a 2.5-cm margin from a patient’s left arm, then applies a 40-sq.-cm skin substitute graft with sutures and dresses the area. How do you code the procedure? Read on to master five tools to ensure accurate, complete claims. 

1. Calculate Size for Excision Procedure

You will use the integumentary malignant lesion excision codes to report your provider’s work in excising the melanoma. Choose 11606 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm).You should calculate the excision size as the lesion diameter plus two times the margin width, experts explain. For the above scenario, that calculation is 3 cm plus (2.5 cm x 2) = 8 cm.

2. Know When to Skip Surgical Prep

Because the provider applied the skin substitute graft immediately following a surgical excision, you should not additionally report a surgical preparation code (15002-+15005, 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 …).

Instead, according to CPT® instruction, “When a primary procedure requires a skin substitute …for definitive skin closure (e.g., … deep tumor removal),” you should report the appropriate graft code in the range 15100-+15278 in addition to the primary procedure (11606 in this case), and skip the surgical preparation codes.

3. Establish the Method of Fixation

Make sure the operative note documents fixation before you use skin replacement graft codes.

CPT® allows the use of these codes only when “the graft is anchored using the provider’s choice of fixation.” The provider’s fixation might involve adhesives, sutures, or staples.

Caution: Don’t code a skin substitute graft if the provider simply applies skin substitute to the wound, even if he stabilizes it with dressing. After ensuring fixation select the proper code(s) from the range 15271-+15278 (Application of skin substitute graft to trunk, arms, legs …).

4. Distinguish Wound vs. Graft Size

If the patient has a large wound but the surgeon covers only part of the wound with skin substitute, you should still select the skin substitute code based on the larger wound size.

Here the provider documents an 8-cm excision, but a 40-sq. cm skin substitute graft. That means you should code the skin substitute graft as 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) plus one unit of +15272 (… each additional 25 sq. cm wound surface area, or part thereof [List separately in addition to code for primary procedure]).

5. Remember the Included Services

According to CPT® instruction, skin substitute grafts include any of the following services, if applicable:

• removal of current graft
• simple cleansing of the wound
• routine dressing supplies
• debridement (except “when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure”).

Code separately: You should separately report debridement if your provider documents conditions outlined in the preceding exception.

CPT® instruction also states that “the supply of skin substitute graft(s) should be reported separately in conjunction with 15271-15278.” That means you should select the appropriate HCPCS Level II code, such as Q4102 (Oasis wound matrix, per square centimeter).