Wiki Need Help with Skin Graft/Transfer codes

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tbensonite

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Greetings all! Would really appreciate some help with skin graft codes. Patient had a right middle finger mass. Our hand surgeon did this procedure and I've got little to no experience coding skin grafting procedures. Here's a snippet of the work done-

...a 2cm X 2cm rhomboid excision of the mass. I had pretty good borders and felt that I was at least 2 mm or greater away from the mass itself. It did not seem to invade into the extensor tendon. I kept the peritenon of the tendon intact. I excised and tagged the distal and long and the radial and short. I sent it off for pathology. I then performed a rhomboid flap. However, the rhomboid flap did not mobilize as much as I wanted to. Skin was pretty nonmobile at that point. I mobilized it as much as I could. A 5-0 nylon secured it. At that point, I saw a deficit of about 15mm X 30mm. I felt that I needed to go ahead and get a full-thickness skin graft...I incised the full-thickness skin graft measuring 2cm X 30mm. At that point, I then defatted the skin graft. I in-set it into the finger. I used 5-0 nylon to secure it. Prior to the in-set of it, I released the tourniquet to make sure I had controlled all the bleeders.
At that point, I then fashioned the skin graft to fit the defect which was 50mm X 30mm. ..I then placed a bolster dressing over the skin graft with cotton balls, mineral oil and Xeroform etc.
I chose 'excisional biopsy of right middle finger mass- 26111, but just not sure about the skin transfer (less than 10 cm2) and the Application of full-thickness skin graft measuring 20mm X 1.5mm X 30 mm.

Anybody who would be willing to get me in the right direction would be my hero:eek:
 
Hello tbensonite,

Since the grafts are coded based on the size of the defect I would query the provider as I see a possible discrepancy :confused: within their documentation-when first mentioned the defect size was 15mm X 30mm and then after fashioning the FTSG they mention the defect size was 50mm X 30mm. Was the 15mm X 30mm the primary defect and 50mm X 30mm the secondary defect? I also would question in my query what location the skin graft was harvested from. The documentation of type of graft, location and size of defect are key to properly coding skin grafts. With the documentation you have given I agree with your CPT 26111 for finger mass and depending on the correct measurements a CPT code from 14040-14041 for the rhomboid flap and CPT 15240-15241 or CPT 15260-15261 depending on size/ location for the FTSG.

Hope this somewhat helps~


M.Hannus, CPC, CPMA, CRC
 
meghanhannus said:
Hello tbensonite,

Since the grafts are coded based on the size of the defect I would query the provider as I see a possible discrepancy :confused: within their documentation-when first mentioned the defect size was 15mm X 30mm and then after fashioning the FTSG they mention the defect size was 50mm X 30mm. Was the 15mm X 30mm the primary defect and 50mm X 30mm the secondary defect? I also would question in my query what location the skin graft was harvested from. The documentation of type of graft, location and size of defect are key to properly coding skin grafts. With the documentation you have given I agree with your CPT 26111 for finger mass and depending on the correct measurements a CPT code from 14040-14041 for the rhomboid flap and CPT 15240-15241 or CPT 15260-15261 depending on size/ location for the FTSG.

Hope this somewhat helps~


M.Hannus, CPC, CPMA, CRC
Click to expand...

Hi Meghanhannus. Your response was very logical and helpful. I will query my doctor outlining these deficiencies and try to get more clarification.
Thank you so much for your time and expertise!
 
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