Multiple new CPT codes appear in 2012
Many new CPT codes pertaining to plastic surgery appear in the 2012 CPT book. The entire skin substitute section has been rewritten, and new codes for injections of Dupuytren's contractural cords are now available.
Skin replacement surgery
The skin replacement surgery section in the CPT book is now divided into three sections:
Autografts/Tissue Cultured Autograft
Skin Substitute Grafts
The surgical preparation codes 15002, 15003, 15004 and 15005 remain unchanged. The use of these codes is addressed in the January 2007 "CPT Corner" (refer also to the CPT Book for guidelines updated in 2011). The autograft codes and their use remain unchanged: they are surface area-dependent and anatomic site-dependent codes.
The allograft and xenograft codes have all been deleted and replaced by eight "skin substitute graft" codes - 15271 through 15278.
Skin substitute grafts
The skin substitute graft codes are used for allografts and xenografts, as well as biological products that form a sheet scaffolding for skin growth. These codes are not to be used for non-graft wound dressings such as gels, ointments, foams or liquids, nor for injected skin substitutes.These codes are reported by anatomic site and surface area (see table). The anatomic site designations are straightforward: One set of codes is used for skin substitute grafts placed on the trunk, arms or legs, including wrists and ankles. A second set of codes is used for skin substitute grafts placed on the face, scalp, mouth, neck, genitalia, hands, feet or digits.
The surface area designation of these codes is not as straightforward, and is, in fact, very confusing. These codes do not "build" or add-on consistently as do all other CPT graft codes. One set of codes is used if the total surface area of application is less than 100 sq cm. An entirely different set of codes is reported for applications totaling 100 sq cm or greater.
If the total surface area of application is less than 100 sq cm, then codes are selected in 25 sq cm increments (see Skin Substitute Grafts table). For example, the application of 25 sq cm of allograft to a hand is reported with code 15275. Each subsequent 25 sq cm of allograft up to 100 sq cm is reported with code 15276. Thus, a 75 sq cm allograft application to the hand is reported:
15276 is an add-on code and does not take the multiple procedure modifier 51. Some payers may require the 59 modifier:
Other payers may require a one-line entry for 15276 with a "2" in the units box:
15275 (one unit)
15276 (two units)
Carefully review the EOBs to ensure accurate payment.
This is where it becomes confusing. If the total surface area of allograft application is 100 sq. cm or greater, one does not build on the previous codes (15275, 15276). Instead, an entirely new set of codes must be used, even for the first 100 sq cm. If the application measures 100 sq cm, code 15277 is reported. Each subsequent 100 sq cm above the initial 100 sq cm is reported with code 15278. Thus, the application of 250 sq cm of allograft to the hands is reported:
Some payers may require the 59 modifier on the second listing of 15278:
The "up to 100 sq cm" codes (15275, 15276) are not used here. Confusing? You bet. The accompanying table will help you see how these codes are reported for surface areas up to 300 sq cm. Once you've coded a few procedures, you'll see how the pattern works.
The skin substitute graft codes are only to be reported when these products are used for skin applications. If these products are used in non-integumentary areas, codes 15271 through 15278 are not used. In these instances the new "biological implant" code is used.
A new code has been created for the use of allogeneic and xenogeneic products placed in non-integumentary areas. Code 15777 is an add-on code and is used in addition to the codes for the primary procedure. If, for example, AlloDerm® is used in a tissue expander breast reconstruction, the procedure is reported:
The injection of Dupuytren's contractural cords with collagenase enzyme is now reported with code 20527. The manipulation of the cord post-enzyme injection is reported with code 26341. Since code 20527 has a zero-day global period, modifier 58 is not appended to code 26341.
■ All previous allograft and xenograft codes have been deleted.
■ New codes have been created for skin substitute grafts (15271 - 15278).
■ For total surface areas up to 100 sq cm, report in 25 sq cm increments, using codes 15271, 15272, 15275, and 15276.
■ For total surface areas 100 sq cm or greater, report in 100 sq cm increments, using codes 15273, 15274, 15277, and 15278.
■ These new codes have zero-day global periods.
■ These new codes are used for integumentary applications of skin substitute grafts.
■ When biologic implants are placed in non-integumentary areas, a new code, 15777 is to be reported.
■ Code 15777 is an add-on code and is to be reported in addition to the primary procedure.
Code of the Month
A tangential excision of a 20 x 6 centimeter full-thickness burn of the forearm
is performed, and the wound covered with AlloDerm®. A split-thickness skin
graft is placed one week later.
15273 Application of skin substitute graft, first 100 sq cm
15274 Application of skin substitute graft, subsequent 100 sq cm
15002-51 Tangential excision, first 100 sq cm
15003 Tangential excision, subsequent 100 sq cm
15100 Split-thickness skin graft, first 100 sq cm
15101 Split-thickness skin graft, subsequent 100 sq cm
- Since the total surface area of skin substitute grafting is greater than 100 sq cm, codes 15273 and 15274 are used. Code 15273 reports the first 100 sq cm. Codes 15271 and 15272 are not used.
- Code 15274 is an add-on code, so the multiple procedure modifier, 51, is not used.
- Tangential excision is considered "surgical preparation," so codes 15002 and 15003 are reported. 15003 is also an add-on code, so the multiple procedure modifier, 51, is not appended.
- Since the skin substitute grafting codes have zero-day global periods, the "staged procedure" modifier, 58, is not appended to the split-thickness skin graft codes.
ICD-9 malignant lesion coding reminder
As of Oct. 1, 2011, the malignant lesion ICD-9 codes (173.XX) must have a fifth digit:
- Fifth digit 1 Basal cell carcinoma (BCC)
- Fifth digit 2 Squamous cell carcinoma (SCC)
- Fifth digit 9 Other specified malignancy (eg, Merkel cell carcinoma, sebaceous carcinoma)
- Fifth digit 0 Unspecified malignancy
For example, a squamous cell carcinoma of the ear is reported with code 173.22.
Submitting claims without a fifth digit may result in rejection of claims.
A tangential excision of a 20 x 6 centimeter full-thickness burn of the forearm is performed, and the wound covered with AlloDerm. One week later a split-thickness skin graft is placed.