Summary & Overview
CPT 15111: Epidermal Autograft for Trunk, Arms, or Legs
CPT code 15111 is a nationally recognized billing code for the surgical procedure of epidermal autograft on the trunk, arms, or legs. This code is significant for hospitals and ambulatory surgery centers, as it captures a critical intervention for patients with burns, ulcers, or chronic wounds requiring skin replacement. The procedure is performed by physicians specializing in surgery, plastic surgery, or reconstructive surgery, and is essential for restoring skin integrity and promoting healing.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Understanding coverage and reimbursement policies for 15111 is vital for providers and health systems to ensure accurate billing and compliance. The publication offers insights into payer-specific policies, typical sites of service, and clinical indications, such as burns and ulcers, that commonly necessitate this procedure.
Readers will gain a comprehensive overview of benchmarks, policy updates, and clinical context for 15111, including its relationship to related codes and modifiers. The summary also highlights the importance of this code in the broader landscape of skin replacement surgery, providing clarity on its use and relevance in modern wound care management.
CPT Code Overview
CPT code 15111 describes the surgical procedure of an epidermal autograft for the trunk, arms, or legs. This procedure involves transplanting the patient's own epidermal tissue to replace damaged or diseased skin, commonly performed in cases such as burns, ulcers, or open wounds. The service is classified under skin replacement surgery and is typically provided in a hospital outpatient or ambulatory surgery center setting (place of service 22 or 24). This code is used to document and bill for the surgical replacement of skin in these anatomical regions, supporting clinical care for patients requiring advanced wound management.
Clinical & Coding Specifications
Clinical Context
A patient presents to the hospital outpatient department with a third-degree burn on the chest wall, involving less than 10% of the total body surface area. The wound is not healing adequately with conservative management. The surgical team, including a plastic and reconstructive surgeon, determines that an epidermal autograft is necessary to promote healing and restore skin integrity. The procedure is performed on the trunk, arms, or legs, depending on the location of the injury. The workflow includes preoperative assessment, harvesting of the epidermal graft from a donor site, preparation of the recipient site, and placement of the graft. Postoperative care involves monitoring for graft viability and wound healing.
Coding Specifications
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Modifier
51: Used when multiple procedures are performed during the same surgical session. Indicates that more than one procedure was done, and may affect reimbursement. -
Modifier
59: Used to denote a distinct procedural service. Applied when procedures are not normally reported together, but are appropriate in certain clinical circumstances.
| Provider Taxonomy Code | Specialty Name |
|---|---|
208600000X |