CPT® Code 15321 | Case2Code

Code deleted, see 15275-15278

Official Description

Allograft skin for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Common Language Description

A skin allograft is a medical procedure involving the application of donor skin to a patient's wound for temporary closure. This procedure is particularly relevant for areas of the body such as the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and multiple digits. The primary purpose of a temporary skin allograft is to provide coverage for extensive wounds, especially in cases of severe burns where the patient's own skin (autogenous skin) is insufficient for adequate wound coverage. These allografts serve a dual function: they not only cover the wound but also act as a dressing that absorbs exudate and prevents the wound from drying out, thereby promoting a more favorable healing environment. The allografts used are typically split-thickness skin grafts that are harvested from cadaver donors and preserved through cryopreservation until they are required for use. During the procedure, the allograft is thawed and meticulously prepared for grafting. It is then applied to the cleaned and prepared wound bed, where it is secured in place using absorbable sutures. Following the application of the allograft, a comprehensive layered dressing is placed over the graft, which includes a nonadherent layer to protect the graft, a bulky layer of gauze for cushioning, a compression layer to minimize swelling, and an anti-shear layer to prevent friction. For billing purposes, the CPT® code 15320 is utilized for the first 100 square centimeters or less in adults or for 1% of total body surface area (TBSA) in infants and children, while CPT® code 15321 is designated for each additional 100 square centimeters in adults or each additional 1% of TBSA in infants and children, or part thereof.

1. Indications

The application of a skin allograft is indicated in various clinical scenarios, particularly when there is a need for temporary wound closure in patients with extensive skin loss. The following conditions may warrant the use of this procedure:

Severe Burns Extensive burns that result in significant skin loss, where the patient's own skin is insufficient for coverage.
Traumatic Wounds Large traumatic wounds that require temporary closure to facilitate healing and protect underlying tissues.
Skin Defects Congenital or acquired skin defects that necessitate temporary coverage until a more permanent solution can be implemented.

2. Procedure

The procedure for applying a skin allograft involves several critical steps to ensure proper placement and effectiveness of the graft. Each step is essential for achieving optimal outcomes.

Preparation of the Wound Bed The first step involves thorough cleaning and debridement of the wound bed to remove any necrotic tissue and prepare the area for grafting. This ensures that the allograft will adhere properly and that the underlying tissue is healthy enough to support healing.
Thawing and Preparing the Allograft The skin allograft, which has been cryopreserved, is then thawed in a controlled manner to maintain its viability. Once thawed, the allograft is carefully inspected and prepared for application, ensuring it is free from any contaminants.
Application of the Allograft The prepared allograft is placed onto the wound bed, ensuring complete coverage of the affected area. It is secured in place using absorbable sutures, which will dissolve over time and do not require removal.
Layered Dressing Application After the allograft is secured, a comprehensive layered dressing is applied. This dressing typically consists of a nonadherent layer to protect the graft, a bulky layer of gauze to provide cushioning, a compression layer to minimize swelling, and an anti-shear layer to prevent friction and movement that could displace the graft.

3. Post-Procedure

Post-procedure care is crucial for the success of the skin allograft. Patients are typically monitored for signs of infection or graft failure. The dressing should remain intact and dry, and patients are advised on how to care for the graft site, including avoiding excessive movement or pressure on the area. Follow-up appointments are necessary to assess the healing process and determine if further interventions are required. The duration of recovery may vary depending on the size of the graft and the patient's overall health, but the goal is to promote healing and prepare for any subsequent procedures that may be needed for permanent skin coverage.

Short Descr	APLY SKNALLOGRFT F/N/HFG ADD
Medium Descr	ALGRFT TEMP CLOSURE F/S/N/H/F/G/M/D EA 100CM
Long Descr	ALGRFT TEMP CLOSURE F/S/N/H/F/G/M/D EA 100CM
Status Code	Active Code
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Discontinued Code
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	172 - Skin graft