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

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

A 42-year-old female with new-onset diabetes presented with a large abscess encompassing almost the entire dorsal aspect of her left foot and a gangrenous fourth toe. After an appropriately aggressive incision and drainage including fourth toe amputation, administration of intravenous antibiotics and local wound care, the wound was adequately clean and viable. (Picture 10).

The size of the wound as well as the exposed tendon and bone put the wound at significant risk for infection or failure to heal if allowed to heal by secondary intention alone. I decided to apply an acellular dermis graft to facilitate healing.

   I debrided the wound and flushed it with a pulse lavage in the operating room. (Picture 11) I placed absorbable calcium sulfate beads with vancomycin. I meshed a 5 x 10 cm Bacterin hMatrix® acellular dermis graft and placed it on the wound. (Picture 12) A VAC® device facilitated healing. The wound was granulated well through the graft over time. (Pictures 13, 14) Sequential applications of Dermagraft then stimulated epithelialization. (Pictures 15-17)

How To Code For Acellular Dermis Graft Procedures

Surgical procedure codes frequently change and are expected to be overhauled if and when the final release and implementation of ICD-10 codes occurs.24,25 At the time of the submission of this article for publication in 2012, the following coding suggestions were felt to be most applicable by this author. Individual insurance payor guidelines may vary. Most procedures (except debridements) have a 90-day global period.

Supply code for acellular dermis graft – Q4107 per square cm

Wound prep of ulcer for graft application
(* specify by surface area/location)
15000 – 15004 (depending on payer guidelines)
Vs. Standard ulcer debridement codes – 11042-11044

Applying The Graft To Wounds

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

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