CPT® Code 15340

Code deleted, see 15271-15278

Official Description

Tissue cultured allogeneic skin substitute; first 25 sq cm or less

Common Language Description

A tissue cultured allogeneic skin substitute is a specialized medical product used to cover wounds or skin defects. This substitute is designed to promote healing by providing a temporary biological covering. It consists of two distinct layers: the upper layer is made up of living human skin cells, specifically keratinocytes, which are responsible for forming the epidermis, the outermost layer of skin. The lower layer is composed of human dermal fibroblasts, which are cultured from the same donor as the upper layer, and these fibroblasts are combined with structural proteins, such as collagen, sourced from animals, typically bovine. This dual-layer structure mimics the natural skin architecture, facilitating better integration and healing at the wound site. Before application, the size of the wound is carefully measured to determine the appropriate amount of the skin substitute needed. The skin substitute undergoes a process called fenestration, where a series of small holes or openings are created in it. This fenestration allows for better drainage and integration with the underlying tissue. Once prepared, the fenestrated skin substitute is applied to the cleaned and prepared wound bed and is secured in place using sutures. To protect the area and support healing, a layered dressing is then applied, which includes a nonadherent layer to prevent sticking, a bulky layer of gauze for cushioning, a compression layer to minimize swelling, and an anti-shear layer to reduce friction. For coding purposes, the CPT® code 15340 is used for the first 25 square centimeters or less of the tissue cultured allogeneic skin substitute, while 15341 is designated for each additional 25 square centimeters or part thereof.

1. Indications

The tissue cultured allogeneic skin substitute is indicated for use in various clinical scenarios where there is a need to cover a wound or skin defect. The following conditions may warrant the application of this procedure:

Wound Coverage The procedure is performed to cover acute or chronic wounds that require a biological dressing to promote healing.
Skin Defects It is indicated for the treatment of skin defects resulting from surgical procedures, trauma, or other medical conditions that compromise the integrity of the skin.
Burns The skin substitute is utilized in cases of partial-thickness burns where traditional wound care may not suffice.

2. Procedure

The application of a tissue cultured allogeneic skin substitute involves several critical procedural steps to ensure effective coverage and healing of the wound.

Step 1: Wound Assessment The first step involves a thorough assessment of the wound to determine its size and characteristics. This assessment is crucial for deciding the appropriate amount of skin substitute required for effective coverage.
Step 2: Preparation of the Wound Bed The wound bed must be cleaned and prepared to ensure optimal conditions for the application of the skin substitute. This may involve debridement of necrotic tissue and ensuring hemostasis.
Step 3: Measurement and Selection of Skin Substitute Once the wound is prepared, the size is measured, and the corresponding amount of tissue cultured allogeneic skin substitute is selected. The substitute is typically available in pre-measured sizes.
Step 4: Fenestration The selected skin substitute undergoes fenestration, where a series of small holes are created. This process is essential for allowing drainage and facilitating integration with the underlying tissue.
Step 5: Application of the Skin Substitute The fenestrated skin substitute is then carefully applied to the prepared wound bed. It is secured in place using sutures to ensure it remains adhered to the wound site.
Step 6: Dressing Application After securing the skin substitute, a layered dressing is applied. This dressing typically includes a nonadherent layer to prevent sticking, a bulky layer of gauze for cushioning, a compression layer to minimize swelling, and an anti-shear layer to protect against friction.

3. Post-Procedure

Post-procedure care is essential for ensuring the success of the tissue cultured allogeneic skin substitute application. Patients should be monitored for signs of infection or complications at the wound site. The layered dressing should be kept intact and may need to be changed according to the healthcare provider's instructions. Patients are typically advised on how to care for the area, including keeping it clean and dry. Follow-up appointments may be scheduled to assess healing progress and determine if additional treatments or interventions are necessary.

Short Descr	APPLY CULT SKIN SUBSTITUTE
Medium Descr	TISSUE CULTURED ALLOGENEIC SKIN 1ST 25CM/
Long Descr	Tissue cultured allogeneic skin substitute; first 25 sq cm or less
Status Code	Active Code
Global Days	010 - Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard 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)	0 - Co-surgeons not permitted for this procedure.
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