Coding Guidelines for Skin Grafts and Flaps

3 important Coding Guidelines for Skin Grafts and Flaps 

What is skin graft?

Providers take healthy skin from one part of the body and transplant (move) it. The healthy skin covers or replaces skin that is damaged or missing. Skin loss or damage can result from burns, injuries, disease or infection.

What are the 5 Types of skin graft?

Based on CPT following types:

1.       Skin substitute
2.       Autograft: Graft from the same person
3.       Allograft/Homograft: Graft from another member of the same species (often cadaveric)
4.     Isograft: Graft from another member of the same species who is genetically identical to the patient (identical twin)
5.      Xenograft/Heterograft: Graft from another species (often porcine or bovine)

Skin Substitute Grafts

It include non-autologous skin (dermal or epidermal, cellular, and acellular) grafts (e.g., homograft, allograft), non-human skin substitute grafts (i.e., xenograft), and biological products that form a sheet scaffolding for skin growth.

Grafts and Flaps

CPT codes describing skin grafts and skin substitutes are classified by size, location of recipient
area defect, and type of graft or skin substitute. For most combinations of location and type of
graft/skin substitute, there are 2 or 3 CPT codes including a primary code and 1 or 2 Add-on
Codes (AOCs). The primary code describes one size of graft/skin substitute and shall not be
reported with more than one unit of service. Larger size grafts or skin substitutes are reported
with AOCs.

1. The primary graft/skin substitute codes (e.g., 15100, 15120, 15200, 15220) are
   mutually exclusive, since only one type of graft/skin substitute can be used at an anatomic site. I
   multiple sites require different types of grafts/skin substitutes, the different graft/skin substitute CPT codes should be reported with anatomic modifiers or modifier 59 or XS to indicate the
   different sites.
   2. Debridement of a skin wound (e.g., CPT codes 11000, 11042-11047, 97597,
   97598) before a graft/skin substitute is included in the skin graft/skin substitute procedure (CPT
   codes 15050-15278) and shall not be reported separately. If the recipient site requires excision of open wounds, burn eschar, or scar or incisional release of scar contracture, CPT codes 15002-15005 may be separately reportable for certain types of skin grafts/skin substitutes.
   3. Debridement (e.g., CPT codes 11000, 11042-11047, 97597, 97598) of the site of a
   tissue transfer is included in the tissue transfer procedure and is not separately reportable.

 Few important Steps to arrive the correct code

•      type of graft or skin substitute
•      size
•      location of recipient area defect
•      Primary code should be reported only once for   one size of graft.
•      Larger size grafts or skin substitutes are reported with add on codes.
•      only one type of graft/skin substitute can be used at an anatomic site
•     If multiple sites require different types of grafts/skin substitutes, the different graft/skin substitute CPT codes should be reported with anatomic modifiers or modifier 59 or XS to indicate the different sites.
•     The measurement of 100sq cm is applicable to adults and children 10 years of age and older.
•      Percentages of body surface area apply to infants and the children younger than 10 years of age.
•     There is no separate CPT code for Wrist and/or Ankle. It should be coded as CPT code of arm or leg in the descriptor.
•     If provider performed biological implant (15777) along with graft. It can be coded with primary procedure

 Can we code Skin graft Preparation Procedure?

1.  Debridement of a skin wound (e.g., CPT codes 11000, 11042-11047, 97597, 97598) before a graft/skin substitute is included in the skin graft/skin substitute procedure (CPT codes 15050-15278) and shall not be reported separately.
2.      If the recipient site requires excision of open wounds, burn eschar, or scar or incision
3.  release of scar contracture, CPT codes 15002-
4.  15005 may be separately reportable for certain
5.  types of skin grafts/skin substitutes.