Urology Coding Alert

Question: I have an operative note for a urethroplasty procedure where the surgeon harvested an oral mucosa graft for reconstruction during the urethroplasty. The provider is saying that we should assign 15240 to report the buccal mucosa graft, but I think 40818 is the correct choice.

What code should we report for the oral mucosa graft?

AAPC Member

Answer: This question has been the subject of discussion in specialty societies and among coding experts before. Code 40818 (Excision of mucosa of vestibule of mouth as donor graft) is the appropriate code as the descriptor is an accurate representation of the procedure performed.

Code 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) is a full-thickness graft to repair a deep wound or tissue defect. A full-thickness graft involves harvesting the epidermis and dermis to transfer it to a recipient site.

On the other hand, 40818 describes harvesting the mucous membrane from the cheek or gums of the mouth for repair elsewhere in the body. In fact, if you search the CPT^® Index for Harvest > oral mucosa or Graft > mucosa, you’ll be directed to 40818 each time.

Beware of fraud: If a provider assigned 15240 in an attempt to collect more revenue for the procedure, they are committing fraud. According to the 2025 Medicare Physician Fee Schedule (MPFS), below are the facility and nonfacility Medicare fees for 40818 and 15240:

As you can see, there are significantly higher fees tied to 15240, and if an auditor found that 15240 was reported for a buccal mucosa graft procedure, all parties involved could face punishment.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC