15004 CPT Code: Know Your Codes
15004 CPT Code Description: Surgical Preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, neck ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children.
Skin Replacement/Surgical Preparation Codes (15002-15005)
Skin replacement codes (15002-15005) apply specifically to describe the work of ‘preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy,’ according to CPT guidelines. Surgical prep codes would not be reported for removal of nonviable tissue or debris in a chronic wound when it is left to heal by secondary intention. When a wound requires serial debridement, report active wound management (97597-97598) or debridement (11042-11047). If a wound requires negative pressure wound therapy, 15002-15005 are applicable in addition to 97605-97606.
Skin replacement codes are used for wound preparation in anticipation of immediate or near-future surgical reconstruction (e.g., flaps, grafts, burns, traumatic wounds, or necrotizing infection). These codes are also used for debridement of wounds that will be or are surgically closed. 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. Anatomic area covered:
- 15002, +15003: trunk, arms, legs
- 15004, +15005: face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits
Skin Replacement Codes Description
- 15002 CPT: Surgical Preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children.
- +15003 CPT: Each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure)
- +15005 CPT: Each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure)
Size of the Recipient Area
- The skin replacement surgery guidelines instruct coders on how to correctly report codes that reference measurements of 100 sq. cm or 1 percent of body area of infants and children. When determining the involvement of body size, the measurement of 100 sq cm is applicable to adults and children 10 years of age and older; percentages of body surface area apply to infants and children younger than 10 years of age. The measurements apply to the size of the recipient area. Procedures involving the wrist and/or ankle are reported with the anatomic codes for the arm or leg.
- Additionally, the graft is anchored using the provider’s choice of fixation, and when services are performed in the office, routine dressing supplies are not reported separately. These codes are not intended to be reported for the application of non-graft wound dressings (for example, gel, ointment, foam, liquid) or injected skin substitutes. These codes were specifically created for treatment of wounds in burn and trauma patients. These codes were not intended to be used for abdominal wall fascial repair or fascial support – in other words, underlay or overlay support.
Coding Guidelines for 15002-15005
- Surgical preparation codes (15002-15005) intended to describe burn and wound preparation or incisional or excisional release of scar contracture resulting in an open wound requiring skin grafts.
- Per the definitions and the guidelines in CPT Code Book codes CPT codes 15002-15005 are not appropriate codes to use when performing a non-surgical application of a skin substitute.
- 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.’ 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 this.
- Surgical preparation codes relate to healing wounds by primary intention, whereas debridement and wound management codes relate to healing wounds by secondary intention. This is why CPT guidelines instruct the user to consider wound management codes (97597, 97598) and debridement codes (11042-11047) in cases in which nonviable tissue is removed from a chronic wound and it is left to heal by secondary intention, and to not report surgical preparation codes 15002-15005.
- CPT code 15002-15005 are only appropriately used in place of service inpatient hospital, outpatient hospital, or ambulatory surgical center with regional or general anesthesia to resurface an area damaged by burns, traumatic injury, or surgery. An operative report is required and must be available upon request.
Example of 15004 CPT Code
The physician excises an open wound or burn eschar, removes an existing scar, or makes an incision to release the skin contracture caused by the scar. Simple debridement or granulation tissue removal may also be done to create a recipient site for skin grafting to repair the defect. After a healthy bed of vascular tissue is prepared, a separately reportable skin graft can be placed on the site of the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, or multiple digits. CPT Code 15004 reports surgical preparation of the first 100 sq cm or 1% of body area of infants or children. Report CPT code 15005 together with code 15004 for each additional 100 sq cm or each additional 1% of body area of infants or children, or any number of additional square centimeters or percentage of child’s body area within those measured amounts.
Use of Modifier 51
CPT instructs the use of modifier 51 on subsequent stand-alone codes. Some Medicare payors may not require the use of this modifier, thus it is critical to obtain written instructions from the payors for accurate claim format submission. Modifier 51 accurately identifies the subsequent procedure as nonprimary and subject to the multiple procedure payment formula. Remember, never append modifier 51 to an add-on code because the add-on code has already been revalued for intraoperative work only. Some payors may require modifiers on the add-on codes or may require the add-on codes to be reported in units. Verify with the payors the appropriate format for claim submission and payment processing.
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