Coding for ankle wounds

Good Morning

We are applying grafts to ankle ulcers and I have a question about the code selection. Is the ankle considered part of the foot or the leg? I think it's leg but the provider's office is coding for the foot. I am trying to decide between these 2 codes:


1. 15271-"application of skin substitute graft to trunk, arms, legs"



2. 15275-"application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet"


Thanks

Beth

Beth Aldridge, CPC
Coding Manager

Northern California Medical Associates, Inc
Phone: (707) 573-6145
Fax: (707) 573-6932

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Comments

  • I have this from AMA...although 2011
    "Small" Leg/Ankle Wounds
    CPT 15271 (application of skin substitute graft to, for example, leg or ankle). This code is
    based on a wound size (after cleansing, prepping, and/or debriding) maximum of 100 sq
    cm. Specifically, this code is to be used for application of a skin substitute graft to a
    wound surface area size of 0 to 25 sq cm (first 25 sq cm within the maximum wound size
    grouping up to 100 sq cm).
    If the leg/ankle wound area is greater than 25 sq cm, but less than the maximum of group size
    up to 100 sq cm, then bill CPT 15271 plus
    CPT 15272 for each additional 25 sq cm of wound surface area. The total wound surface area
    treated cannot exceed 100 sq cm so you have the ability to bill CPT 15272 3 times, for example,
    if skin substitute graft material is applied to 75.1 up to 100 sq cms of leg/ankle wound(s). Since
    CPT 15272 is an "add-on" code, you would NOT apply a "-51" modifier. It is already discounted.
    "Large" Leg/Ankle Wounds
    CPT 15273 (application of skin substitute graft to, for example, leg or ankle). This code is
    based on a wound size (singular or aggregate size; after cleansing, prepping, and/or
    debriding) minimally of 100 sq cm*. Specifically, this code is to be used for application of
    a skin substitute graft to a wound surface area size of 100 up to 200 sq cms (the code
    itself represents the first 100 sq cm of a "large" leg/ankle wound treated).

    If the leg/ankle wound area is greater than 100 sq cm, then bill CPT 15273 plus
    CPT 15274 for each additional 100 sq cm* of wound surface area. For example, if you have an
    aggregate sum of leg/ankle wound area calculated to be 375 sq. cm present bilaterally, you
    would bill CPT 15273 (first 100 sq cm), CPT 15274 (next 100 sq cm), CPT 15274 (next 100 sq
    cm), and CPT 15274 (next 75 sq cm). Since CPT 15274 is an "add-on" code, you would NOT
    apply a "-51" modifier. It is already discounted.
    * or 1% of body area of infants and children

    Small" Foot/Toe Wounds
    CPT 15275 (application of skin substitute graft to, for example, foot or toe(s)). This code is
    based on a wound size (after cleansing, prepping, and/or debriding) maximum of 100 sq
    cm. Specifically, this code is to be used for application of a skin substitute graft to a
    wound surface area size of 0 to 25 sq cm (first 25 sq cm within the maximum wound size
    grouping up to 100 sq cm).

    Mindy L Dowd CPC,CPMA
    Denver Arthritis Clinic
    200 Spruce St
    Suite 100
    Denver,CO 80230
    (303)302-7433
    mdowd@dacdenver.com

  • ICD-10-CM combines ankle/foot in their muscle tendon guidelines if that is any help.
    Maxine

    [Description: Description: R:GeneralGraphicsScrogginsGrearCorrect ColorsScrogginsGrear One Line Signature.png]

    Maxine Lewis, CMM, CPC, CPC-I, CCS-P, CPMA
    Main: 513-771-7070
    Direct: 513-672-4363
    Fax: 513-326-7640
    200 Northland Blvd
    Cincinnati, OH 45246
    mlewis@scrogginsgrear.com
    www.scrogginsgrear.com

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