Replacements for Autologous Skin Grafts

A partial thickness skin graft is anything less than full thickness.  A full thickness skin graft is comprised of the dermal and subcutaneous layers.  Code what is being replaced.  These types of grafts are considered free graft devices.

Preparation of the wound is not coded separately when it is performed at the same time as the skin replacement procedure.  The excision or resection of the native body is not coded when the replacement procedure is performed (except for mastectomy).

When coding skin grafts using autologous tissue, two codes are required:

1. Replacement of skin by location and qualifier for depth
2. Excision (harvesting) of skin from the donor location

Epidermal Cultured Autograft: A skin biopsy or specimen is taken from the patient with an injury.  Keratinocytes are isolated from the specimen.  Feeder cells are added to provide for cell seeding and inoculation, forming a culture.  A thin sheet is then prepared.  This process takes approximately two weeks.  It is coded as autologous partial thickness replacement.

Epidermal Autograft Harvesting: Four centimeters are harvested from the patient and then grown to approximately 100 square centimeters for grafting.

Autologous Cell Suspension: The isolation of epidermal cells from the epidermis by a one-enzyme approach or two-enzyme approach using trypsin, EDTA or dispase II. The epidermal cells are taken as skin biopsies, either split or full thickness taken from healthy skin such as thigh, gluteal and groin regions using a dermatome.  Only foreskin is acquired with a scalpel.    

Alloderm Dermal Matrix: Allograft tissue composed of generative tissue matrix containing complex acellular heterogenous scaffold and growth factor.  It comes dehydrated and ready to implant to bind tissue sites and blood vessel architecture. 

StataGraft: A new technology bioengineered skin allograft with layers of both dermis and epidermis like full-thickness tissue.  It is used on thermal burns.  There is only one code assigned, XHRPXF7.

The PCS Table for skin, OHR, contains three Device characters:

• 7 – autologous tissue substitute
• J – Synthetic Substitute
• K – Nonautologous Tissue Substitute
• Device character 7, autologous tissue substitute, permits the following qualifiers:2 cell suspension technique
• 3 full thickness
• 4 partial thickness

Device character K, nonautologous tissue substitute, permits the following qualifiers:

• 3 full thickness
• 4 partial thickness

Device character J, synthetic substitute, permits the following qualifiers:

• 3 full thickness
• 4 partial thickness
• Z no qualifier

Replacements – Multi-Layer or Composite:

Two or more contiguous layers of tissue.  Tissue can be composed of skin, subcutaneous, and/or bone.  The replacement used is named for the muscle, examples:  arterial supply of the bone; deep inferior epigastric artery perforator flap or fibular osteocutaneous flap.    Note:  code the replacement of all body parts replaced to include the individual layers affected.