Otolaryngology Coding Alert

Question: I have trouble understanding CPT® code 30620. Part of the descriptor reads “does not include obtaining graft.” Does that mean the code represents only preparation of the recipient site, and application of the graft? Why does the code imply that obtaining the graft is coded separately when there is no code for harvesting a split-thickness skin graft? How should I code the grafting of split-thickness skin autograft from the thigh to the septum, after endoscopic debridement? 

Nevada Subscriber

Answer: The descriptor for 30620 reads, “Septal or other intranasal dermatoplasty (does not include obtaining graft).” Under range specific guidelines, CPT® states, “For obtaining tissues for graft, see 20900-20926, 21210.” 

When a split thickness graft is used, the surgeon generally harvests from the anterior thigh wall. The graft is attached and sutured into the area of the nose that is affected and the incision is closed. Obtaining of graft should be separately reportable in most, if not all, cases. 

CPT® guidelines have the harvesting of the split thickness graft from the thigh defined by 15100 (Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children [except 15050]). The lay description for this code from Codify states: “This procedure is a split–thickness autograft from the trunk, arms, or legs.  This excision and placement is for the first 100 square cm or less or 1% of the body area of an infant or child. Clinical Responsibility: A dermatome is used to harvest skin 0.01–0.015 inches in depth that is to be transplanted from the patient’s donor site to a burn or wound site of the same patient to provide closure. This graft contains both epidermis and dermis (but not full thicknesses).”  Code 15100 describes the harvesting of the split thickness graft that will grafted onto the septum in 30620.