Graft coding: Expert reviews AMA's current terminology

July 1, 2008

Current Procedural Terminology codes were significantly changed in 2007 to clarify previous confusion, and physicians must understand the changes in order to submit the correct billing and, ultimately, to be reimbursed, one expert says.

Key Points

Williamsburg,Va. - Dermatologists need to apply the right billing code for each procedure that they perform on the skin, and any misreporting can result in underpayment to the physician or overpayment by insurers, which can be viewed as an abuse of the system, whether done on purpose or inadvertently.

To help circumvent the confusion encountered in coding, one expert reviews the Current Procedural Terminology (CPT) graft coding from the American Medical Association (AMA) that dermatologists need to strictly follow, hopefully putting to rest any ambiguities.

"A significant amount of confusion has been spawned by the addition of a multitude of engineered tissue product CPT codes, and dermatologists and plastic surgeons found it, at times, difficult to ascribe the correct code for the procedures that they perform. This ambiguity (in) applying the 'right' code can be especially felt with the newer codes," says Daniel Mark Siegel, M.D., M.S., clinical professor of dermatology and director of procedural dermatology fellowship, SUNY Downstate, Brooklyn, New York.

CPT divides skin grafts into epidermal, dermal, split-thickness and full-thickness grafts. These grafts can be realized through several different methods and technologies. The CPT also differentiates between a skin replacement, a skin substitute, and temporary wound closure.

Coding challenges

The coding can be very different when a physician is performing grafts of different sizes or from different parts of the body, and whether an autograft is performed or an allograft, either epidermal, dermal, split- or full-thickness skin graft.

In order to code properly in such cases, Dr. Siegel suggests using the prescribed base code unit and the "add-on" codes based on the total size of the graft.

Sometimes, the definitions that physicians employ to describe certain procedures they use in wounds and woundcare and the definitions that the CPT uses for the same procedure do not entirely match. Therefore, problems may arise when coding for a given procedure performed.

Physicians need to get on the same page with the new CPT codes in order to avoid any unpleasantries with payers such as Medicare, Medicaid and other healthcare institutions.

Many types of grafts differ in their indication and their precise application, which may not always coincide with the actions or decisions of the physician.

Dr. Siegel says it would behoove physicians to search the Internet for each specific graft to find out more precise information.