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15004 with 14060

Donna m Posted Fri 23rd of May, 2014 17:06:51 PM

I submitted this on 05/21/2014 but am not sure if it took. I do not see it anywhere.
"Can I bill 15004 with 14060? We have only ever ysed 15004 for skin grafts and flaps, not adjacent tissure transfers. The Dr. is debriding the devitalized tissue from a Moh's wound done by another provider the day before.

SuperCoder Answered Tue 27th of May, 2014 16:16:50 PM

When your surgeon uses a skin graft to close a secondary defect, you may report the procedure in addition to the tissue transfer, as follows:

- 15100-15136 for autologous skin grafts

- 15150-15157 for autologous tissue-cultured epidermal grafts

- 15040 for autologous keratinocytes and dermal tissue harvesting for tissue-cultured skin grafts
- 15170-15176 for acellular dermal replacement.

In addition, you may report surgical preparation of the recipient site, when required, using the following codes (as appropriate to location and total area prepared):

- 15002 -- 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 --- each additional 100 sq cm or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure)

- 15004 -- 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, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children

- +15005 -- - each additional 100 sq cm or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure).

Flap Repairs Take Many Forms

When looking over your surgeon's operative notes, you can recognize adjacent tissue repairs by any of the following terms:

- A-T flap
- Z-plasty
- W-plasty
- V-Y plasty
- O-Z plasty
- Rotation flaps
- Single advancement flaps
- Double advancement flaps
- Rhomboid flaps
- Bilobed flaps
- Double pedicle flap

Specifically, CPT 2007 instructs, -Codes 15002-15005 describe burn and wound preparation or incisional or excisional release of scar contracture resulting in an open wound requiring a skin graft.-

What constitutes site preparation that would warrant billing 15002-15005? According to the September 1997 CPT Assistant, -Usually, the untreated site contains uneven layers or multiple layers that pose a problem, not only facilitating the connection of the surfaces (to maximize graft survival) but accommodating the graft to cause minimal visualization of the graft site.-

Donna m Posted Tue 27th of May, 2014 19:00:32 PM

Ok just so I have it right. This appears to be a single advancement flap which would be billed as an adjacent tissue transfer of 14060 and it is ok to bill the 15004 for preparing the op wound that was already there from the day before by another provider. Correct?

SuperCoder Answered Wed 28th of May, 2014 08:03:11 AM

Correct.

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