How To Use CPT Code 15260

CPT code 15260 describes the procedure for a free full-thickness skin graft of the nose, ears, eyelids, and/or lips that is 20 cm2 or less in size. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 15260?

CPT 15260 is a code used to describe the procedure for a free full-thickness skin graft of the nose, ears, eyelids, and/or lips that is 20 cm2 or less in size. This procedure involves the removal of skin from a donor site and its transfer to the recipient bed. The provider then closes both the donor and recipient sites. This code is specifically used for grafts that involve the entire dermal layer, including the full epidermis and dermis.

2. Official Description

The official description of CPT code 15260 is: ‘Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips 20 sq cm or less.’

3. Procedure

The procedure for CPT code 15260 involves the following steps:

1. The provider assesses the patient’s condition and determines the need for a full-thickness skin graft.
2. A donor site is selected, typically from an area of the patient’s body with excess skin.
3. The provider removes the skin from the donor site, ensuring to include both the full epidermis and dermis.
4. The graft is transferred to the recipient bed, which is the area on the nose, ears, eyelids, and/or lips that requires reconstruction.
5. The provider then closes both the donor and recipient sites, ensuring proper healing and minimizing the risk of infection.

4. Qualifying circumstances

CPT code 15260 is used for patients who require a full-thickness skin graft of the nose, ears, eyelids, and/or lips that is 20 cm2 or less in size. This procedure is typically performed to repair or replace defective or missing tissue or structures in these areas. It is important to note that this code specifically applies to grafts that involve the entire dermal layer, including the full epidermis and dermis.

5. When to use CPT code 15260

CPT code 15260 should be used when a provider performs a free full-thickness skin graft of the nose, ears, eyelids, and/or lips that is 20 cm2 or less in size. It is important to accurately measure the size of the graft to ensure proper coding. If the graft is larger than 20 cm2, an additional add-on code, such as CPT code 15261, should be used for each additional 20 cm2 or part thereof.

6. Documentation requirements

To support a claim for CPT code 15260, the provider must document the following information:

• Patient’s diagnosis and the need for a full-thickness skin graft
• Size of the graft (20 cm2 or less)
• Specific location of the graft (nose, ears, eyelids, and/or lips)
• Date of the procedure
• Details of the procedure, including the donor site and recipient bed
• Direct closure of the donor site
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 15260, ensure that the procedure meets the criteria specified in the code description. The provider should perform a free full-thickness skin graft of the nose, ears, eyelids, and/or lips that is 20 cm2 or less in size. If the graft is larger than 20 cm2, an additional add-on code, such as CPT code 15261, should be used. It is important to follow the guidelines provided by the payer and submit accurate documentation to support the claim.

8. Historical information

CPT code 15260 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 15260

There are several similar codes to CPT code 15260 that are used for different procedures. These include:

• CPT code 15040: Split-thickness graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children
• CPT code 15050: Split-thickness graft, 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)
• CPT code 15200: Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less
• CPT code 15220: Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
• CPT code 15240: Full thickness graft, free, including direct closure of donor site, eyelids, nose, ears, and/or lips; 20 sq cm or less

9. Examples

1. A patient undergoes a free full-thickness skin graft of the nose to reconstruct a defect caused by trauma.
2. A provider performs a full-thickness skin graft of the eyelids to repair a congenital malformation.
3. A patient receives a free full-thickness skin graft of the lips to reconstruct tissue lost due to cancer surgery.
4. A provider performs a full-thickness skin graft of the ears to repair damage caused by burns.
5. A patient undergoes a free full-thickness skin graft of the nose and ears to reconstruct tissue lost in an accident.