Association for the Advancement of Wound Care - Professional Services

ALERT: Major Changes to the 2012 Skin Replacement Surgery CPT® Codes

The AMA CPT® Editorial Panel has made significant changes to the 2012 CPT Manual section “Skin Replacement Surgery” for codes related to skin replacement surgery.

The autograft and tissue cultured autograft codes [CPT 15040-15157] remain the same, however their descriptors have been revised for the wound size range assigned to each code.

CPT codes 15170-15431 (32 CPT codes) for skin substitute grafting will be deleted on January 1, 2012.

Effective January 1, 2012, eight new skin replacement surgery codes [CPT 15271 - 15278) will replace CPT codes 15170-15431. These are for the application of “non-autologous human skin (dermal or epidermal, cellular and acellular) grafts, non-human skin substitute grafts (i.e., xenograft), and biological products that form a sheer scaffolding for skin growth”. The new codes are grouped by anatomical location and then by wound size range.

Group One [CPT 15271-15274] represents the trunk, arms, legs (includes the ankle) areas:

“Small” leg/ankle skin substitute graft codes [15271-15272]; wounds known to have an aggregate wound size (after cleansing, prepping, and/or debriding) up to a maximum of 100 sq cm.

  • CPT 15271 represent the first 25 sq. cm,
  • CPT 15272 each additional 25 sq. cm up to that maximum 100 sq cm wound area or 1% of body area of infants and children.

“Large” leg/ankle skin substitute graft codes [15273-15274]; singular or aggregat size (after cleansing, prepping, and/or debriding) wound size beginning at 100 sq cm or greater minimally 100 sq cm or larger.

  • CPT 15273 represent the first 100 sq. cm or 1% of body area of infants and children
  • CPT 15724 represents each additional increments of 100 sq. cm or 1% of body area of infants and children.

Group Two [CPT 15275-15278] codes represent face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits.

“Small” foot/toe skin substitute graft codes [15275-15276]; wounds known to have an aggregate wound size (after cleansing, prepping, and/or debriding) up to a maximum of 100 sq cm.

  • CPT 15275 represent the first 25 sq. cm,
  • CPT 15276 each additional 25 sq. cm up to that maximum 100 sq cm wound area or 1% of body area of infants and children.

“Large” foot/toe skin substitute graft codes [15277-15278]; singular or aggregate size (after cleansing, prepping, and/or debriding) wound size beginning at 100 sq cm or greater minimally 100 sq cm or larger.

  • CPT 15277 represents the first 100 sq. cm or 1% of body area of infants and children.
  • CPT 15278 represents each additional increments of 100 sq. cm or 1% of body area of infants and children.

NOTE: Sizes listed in “Skin Replacement Surgery” are based on the size of the recipient area.

Removal of codes G0440 and G0441

The Medicare Physician Fee Schedule Final Rule announced that CMS will no longer use the G codes (G0440 and G0441) for application of Dermagraft and Apligraf application, beginning January 2012. Instead the CPT codes adopted by the AMA CPT Editorial Panel the new anatomical group codes [CPT 15271 - 15278), to report the application of skin substitute grafts.

Key Summary Points

  • Wound preparation codes are separate from skin substitute graft application codes.
  • The ankle is considered the “leg” in terms of skin substitute graft application.
  • The wound area size that the skin substitute grafts will be applied to is measured after wound preparation/debridement.
  • Bill either the “small” leg/ankle skin substitute graft codes or the “large” skin substitute graft codes
  • Bill the “small” foot/toe skin substitute graft codes or the “large” skin substitute graft codes
  • You can bill both the leg/ankle and the foot/toe skin substitute graft application codes, if you are treating both the leg/ankle and the foot/toe.
  • You do not discount an “add-on” code or do not apply a “-51” modifier, it is adjusted in the code.

Specific Coding Instruction – CPT Editorial panel Guidelines

Skin Preparation Codes

According to the AMA CPT Editorial Panel guidelines for the ‘skin replacement surgery’, the surgical preparation codes, [CPT 15002-15005] “are to be used for the initial traumatic wound preparation (removal of appreciable nonviable tissue) and cleaning to provide a viable wound surface (primary intention healing) for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy.” Primary intention presumes that the performance of the skin preparation and the application of the autograft, flap, skin substitute graft or for negative pressure wound therapy is to heal the wound.

CPT 15002-15005 are not to be used for the removal of nonviable tissue/debris in chronic wounds left to heal by secondary intention.
CPT 11042-11047 and CPT 97597-97598 are to be used for removal of nonviable tissue/debris in chronic wounds left to heal by secondary intention this.

CPT 15002-15005 are selected based on the anatomic area and size of the prepared/debrided defect. For multiple wounds, the choice of code is based on the aggregate sum of the surface area of all similarly grouped wound types

Autografts and Tissue Cultured Autografts

Application of autografts and tissue cultured autografts include both the harvesting and placement of the autologous skin graft.

  • Repair of the donor site is reported separately.

Debridement is separately reimbursed only when there is “extensive cross contamination” that requires prolonged cleansing, and appreciable amounts of devitalized or contaminated tissue is removed; or if the debridement is obvious to be medically necessary and performed separately without immediate primary closure.

Skin Substitute Grafts

Application of skin substitute grafts, according to the 2012 CPT, include “non-autologous human skin (dermal or epidermal, cellular and acellular) grafts, non-human skin substitute grafts (i.e. xenograft), and biological products that form a sheer scaffolding for skin growth.”

These codes are NOT reported for injected skin substitutes.

NOTE: Debridement is separately reimbursed only when there is “extensive cross contamination” that requires prolonged cleansing, and appreciable amounts of devitalized orcontaminated tissue is removed; or if the debridement is obvious to be medically necessary and performed separately without immediate primary closure.

New 2012 CPT Skin Substitute Grafting Codes

“Small” Leg/Ankle Wounds

CPT 15271 (application of skin substitute graft to, for example, leg or ankle). This code is based on a wound size (after cleansing, prepping, and/or debriding) maximum of 100 sq cm. Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 0 to 25 sq cm (first 25 sq cm within the maximum wound size grouping up to 100 sq cm).

If the leg/ankle wound area is greater than 25 sq cm, but less than the maximum of group size up to 100 sq cm, then bill CPT 15271 plus CPT 15272 for each additional 25 sq cm of wound surface area. The total wound surface area treated cannot exceed 100 sq cm so you have the ability to bill CPT 15272 3 times, for example, if skin substitute graft material is applied to 75.1 up to 100 sq cms of leg/ankle wound(s). Since CPT 15272 is an “add-on” code, you would NOT apply a “-51” modifier. It is already discounted.

“Large” Leg/Ankle Wounds

CPT 15273 (application of skin substitute graft to, for example, leg or ankle). This code is based on a wound size (singular or aggregate size; after cleansing, prepping, and/ordebriding) minimally of 100 sq cm or 1% of body area of infants and children. Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 100 up to 200 sq cms (the code itself represents the first 100 sq cm of a “large” leg/ankle wound treated).

If the leg/ankle wound area is greater than 100 sq cm, then bill CPT 15273 plus CPT 15274 for each additional 100 sq cm or 1% of body area of infants and children of wound surface area. For example, if you have an aggregate sum of leg/ankle wound area calculated to be 375 sq. cm present bilaterally, you would bill CPT 15273 (first 100 sq cm), CPT 15274 (next 100 sq cm), CPT 15274 (next 100 sq cm), and CPT 15274 (next 75 sq cm). Since CPT 15274 is an “add-on” code, you would NOT apply a “-51” modifier. It is already discounted.

“Small” Foot/Toe Wounds

CPT 15275 (application of skin substitute graft to, for example, foot or toe(s)). This code is based on a wound size (after cleansing, prepping, and/or debriding) maximum of 100 sqcm. Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 0 to 25 sq cm (first 25 sq cm within the maximum wound sizegrouping up to 100 sq cm).

If the foot/toe wound area is greater than 25 sq cm, but less than the maximum of group size up to 100 sq cm, then bill CPT 15275 plus CPT 15276 for each additional 25 sq cm of wound surface area. The total wound surface area treated cannot exceed 100 sq cm so you have the ability to bill CPT 15272 3 times, for example, if skin substitute graft material is applied to 75.1 up to 100 sq cms of foot/toe wound(s). Since CPT 15276 is an “add-on” code, you would NOT apply a “-51” modifier. It is already discounted.

“Large” Foot/Toe Wounds

CPT 15277 (application of skin substitute graft to, for example, foot or toe(s)). This code is based on a wound size (singular or aggregate size; after cleansing, prepping, and/ordebriding) minimally of 100 sq cm or 1% of body area of infants and children. Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 100 sq cm and up, but the code itself represents the first 100 sq cm of the foot/digit wound(s) treated.

If the foot/toe wound area is greater than 100 sq cm, then bill CPT 15277 plus CPT 15278 for each additional 100 sq cm or 1% of body area of infants and children of wound surface area. For example, if you are treating a patient with an aggregate sum of foot/toe wound area calculated to be 375 sq. cm present bilaterally, you would bill CPT 15277 (first 100 sq cm), CPT 15278 (next 100 sq cm), CPT 15279 (next 100 sq cm), and CPT 15278 (next 75 sq cm). Since CPT 15278 is an “add-on” code, you would NOT apply a “-51” modifier. It is already discounted.