Frequently assigned codes 15000 and 15001 were revised for 2006 and their use expanded. Currently (for 2005) the terminology reads:
15000 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues); first 100 sq cm or one percent of body area of infants and children
15001 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues); each additional 100 sq cm or each additional one percent of body area of infants and children (List separately in addition to code for primary procedure)
For 2006 the codes above were revised to include "incisional release of scar contracture" because this is a commonly performed procedure in burn cases.
Two other commonly assigned codes were also revised to ensure that their use is consistent with the addition of the new codes. These include codes 15100 and 15120, which both represent split-thickness skin grafting procedures. In place of "Split graft," the terminology has been further revised to read "Split-thickness autograft."
Two existing codes from 2005 (15400 and 15401) that represent xenografts were also revised to include terminology related to these grafts involving the dermal layer and being used for temporary wound closure. Because these grafts are taken from other species (most commonly porcine or pigskin), they are typically rejected after some time and so are used for temporary wound closure purposes. Products include EZ DermT and Mediskin®. Two new codes for related xenografts are available for use in 2006 (primary code 15430 for the first 100 square centimeters and corresponding add-on code 15431 for each additional 100 square centimeters). The most common products used are Oasis® and Surgisis® and these grafts are comprised of decellularized porcine connective tissue, whose strength make them ideal for soft tissue reinforcement grafting purposes.
New codes include 15110 and 15115, which represent epidermal autografts of various body sites. These primary codes involve the first 100 sq cm of the recipient site grafted. Corresponding add-on codes 15111 and 15116 are also available to reflect services that involve each additional 100 sq cm of epidermal autograft. Coders should review documentation to ensure that the graft only includes the most superficial epidermal layer, which is extremely thin (typically 5 6 thousandths of an inch), and is very hard to handle. These grafts are harvested from the patient's own body (autograft).
Dermal autografts (involving the deeper layer of skin) correspond to primary codes 15130 and 15135, differentiated by body site of the recipient grafting site. These codes also involve the first 100 sq cm of the recipient site grafted and corresponding add-on codes 15131 and 15136 are also available to reflect services that involve each additional 100 sq cm of dermal autograft. Once again, documentation should specify that the grafts are harvested from the patient's own body (autograft). These grafts may be harvested utilizing two passes of a dermatome.
When the operative report indicates that an autograft involves a tissue cultured process, codes 15150 through 15157 should be reported for these grafting procedures. The grafts themselves are cultured in smaller pieces, so the primary codes (15150 and 15155) include only the first 25 sq cm. Two add-on codes are available for each primary code, the first involving grafts with additional measurements of 1 sq cm to 75 sq cm (15151 and 15156) and the other involving each additional 100 sq cm (15152 and 15157). The tissue cultured process is typically used when the patient does not have enough unaffected (unburned) skin to provide a primary graft. A small portion of this tissue is taken and cultured in a lab, which greatly increases its size. This harvesting process may be reported separately with new code 15040. All of the codes in range 15040 through 15157 are found under the new Autograft/Tissue Cultured Autograft section. The grafting products that involve only the epidermal layer include CEA, Epicel® and EpiDex®.
Acellular dermal replacement grafts are reported with primary codes 15170 and 15175 for the first 100 sq cm, again differentiated by body site. The corresponding add-on codes represent each additional 100 sq cm. These grafts involve a synthetic replacement material in which the dermal layer is permanent, but a temporary silicone top layer requires epidermal grafting at a later date. The product most commonly used for this type of graft is Integra®.
Dermal grafts may also be placed using tissue from another human donor (allograft) or in combination with skin replacement products. Primary codes 15330 and 15335 are reported for these services for the first 100 sq cm, differentiated by body site, along with their corresponding add-on codes 15331 and 15336 for each additional 100 sq cm measured at the recipient site. Most commonly, the Alloderm® product is used for these procedures and it requires immediate concurrent coverage with human tissue.
Tissue cultured allogeneic skin substitute products are produced in the laboratory and contain both a dermal and epidermal layer; the product Apligraf® is commonly used for these procedures and primary code 15340, along with corresponding add-on code 15341 are reported for these services. These products are typically used in 25 sq cm increments and the codes match these dimensions.
When a tissue cultured allogeneic skin substitute product involves only the dermal layer, a code from the 15360 through 15366 range should be reported. These codes are also differentiated by body site and include primary codes (15360 and 15365) for the first 100 sq cm grafted at the recipient site and corresponding add-on codes (15361 and 15366) for each additional 100 sq cm. Common products currently available are derived from cultured allogeneic neonatal dermal fibroblasts and include Transcyte® and Dermagraft®.