Ask the Expert

This month’s selection:
I transcribe for a plastic and reconstructive surgeon. He often gets referrals from dermatologists who send patients following Mohs surgery for closure of the open wound. The doctor has begun using 15002 along with the closure code (unless the closure code includes excision/wound prep, such as 14060) to code the procedure. He also used 15002 and 15003 to code a scar revision (56 cm X 3 cm, closure codes 13101 and 13102 X 10). Is this correct? Is 15002 appropriate for these types of procedures?

Jane C.
Fort Lauderdale, Florida

 

Response:
Usually closure of an open wound after Mohs surgery is achieved with either an adjacent tissue transfer (14000 to 14302), complex closure (13100 to 13160), or intermediate repair (12031 to 12057), depending on the type of closure required.

The use of CPT code(s) 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; and 15003, same as 15002 but for 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) would be inappropriate as these codes are listed in the CPT Manual under “Skin Replacement Surgery and Skin Substitutes.” Please keep in mind the following when using these codes:
 
• Use when preparing a proper wound surface for the placement of a graft, flap, skin replacement, skin substitute, or negative pressure therapy.

• Appreciable nonviable tissue is always removed.

• A clean wound bed may be created by incisional release of a scar contracture, resulting in a surface defect from separation of tissue.

• The purpose of these codes is to prepare the wound to heal by primary intention or negative pressure wound therapy.

• The patient’s condition may require that final closure may be delayed.

• Codes 15002 to 15005 should not be reported for the removal of nonviable tissue/debris in a chronic wound (eg, venous or diabetic) when the wound is left to heal by secondary intention.

Regarding scar revisions, the CPT guidelines for complex repair codes includes the repair of wounds requiring more than layered closure, viz., scar revision. Debridement, extensive undermining, stents or retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions.

— Jacqueline Thelian, CPC, CPC-I, is a healthcare consultant and educator with more than 20 years of experience in business management and medical coding. She has been involved in physician practice management, billing, and reimbursement issues and has taught extensively in academic medical centers, hospitals, and private physician practices.