Exploring The Potential Of Acellular Dermis Grafts For Wound Healing And Soft Tissue Repair

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Author(s): 
J. Palmer Branch, DPM, FACFAS

15271 Allograft temporary wound closure - legs; first 25 cm2 or less
15272 Allograft temporary wound closure - legs; each additional 100 cm2
15273 Allograft temporary wound closure - legs; first 100 cm2 or less
15274 Allograft temporary wound closure - legs each additional 100 cm2
15275 Allograft temporary wound closure - feet; first 25 cm2 or less
15276 Allograft temporary wound closure – feet; each additional 25 cm2
15277 Allograft temporary wound closure - feet; first 100 cm2 or less
15278 Allograft temporary wound closure - feet each additional 100 cm2

Negative Pressure Wound Therapy Monitoring (In General)

97605 - Less than 50 cm2
97606 - Greater than 50 cm2
*No global period – either code.
*Application of VAC generally not reimbursable.

Tendon Repair

Repair of extensor tendon
Foot – 28208
Ankle/leg - 27664

Repair of extensor tendon, secondary, with or without graft
Foot - 28210
Ankle/leg - 27665

Repair of Achilles tendon –primary –open or percutaneous – 27650
With graft – primary 27652

Repair, secondary, Achilles tendon with or without graft - 27654

Repair of flexor tendon (primary or secondary)
Foot - 28200
Ankle/leg - 27658

Repair of flexor tendon with free graft (includes obtaining graft)
Foot - 28202
Ankle/leg - 27665

   There has been some debate among various coding experts on whether the acellular dermis graft warrants the graft repair code. It is the opinion of this author that the application and suturing or weaving of an acellular dermis graft to strengthen the repair site does represent adequate work to warrant billing of this higher level code.

Ankle Ligament Repair

Primary Brostrom repair – single ligament – 27695
Both collateral ligaments – 27696
Secondary anatomic ligament reconstruction with graft- 27698

   It would be my opinion that the simple onlay graft of the dermis graft over a Brostrom-type repair would be billable as a primary repair. Procedures where the dermis graft is used in more substantial ligament reconstructive techniques would be more appropriately billed at the higher code level.

Joint Resurfacing

Arthroplasty of first metatarsophalangeal joint – 28292 (generally applicable for use of dermis graft resurfacing)

Arthroplasty of first metatarsophalangeal joint with metallic or silicone implant- 28293

Arthroplasty of lesser metatarsophalangeal joint – 28288
(same code for ostectomy, partial of each metatarsal head)

Arthroplasty of ankle – 27700

   Although there is a code for ankle arthroplasty with implant (27702), this generally refers to the metallic ankle implants. This is significantly different from the resurfacing procedure. Consideration could be given for use of the ankle arthroplasty code with a -22 modifier (“additional work”) or to use the unlisted procedure code (28899). Preauthorization from private insurance carriers may be necessary, depending on the payor.24,25

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