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ICD-10-PCS: Epidermal Autografting


by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA

ICD-10-PCS FY2020 brings us another different way to complete the process of epidermal autografting – a new method called cell suspension technique. Let’s compare this new technique to the other ways the epidermis, the outermost layer of skin, can be grafted from the patient’s own skin.

The cell suspension technique from ReCell® has a new qualifier value of 2 in the Replacement table for skin (0HR table) and the technique provides immediate cover for lost or damaged epidermis. In this technique, the surgeon harvests a small split-thickness sample of the patient’s healthy skin. Using a biochemical process, the epidermis is separated from other components and suspended into a solution, which is sprayed or dripped onto the open wound. The surgeon performs the entire process during one operative room session. This can be performed at the same operative session as any required debridement.

Don’t confuse this new technique with epidermal tissue cultured autografting. In this culturing process, the same small piece of healthy epidermis, about 4 square centimeters, is harvested and sent to a special laboratory where it is cultured into about 75 square centimeters over a period of two weeks. Multiple units can be cultured at the same time. The new cultured epidermis is then sent back to the hospital and the patient returns to the operating room for application of their own larger-size cultured epidermis. This is assigned qualifier value 4, Partial Thickness in the 0HR table along with an autologous tissue substitute device. The advantage of the method is the patient’s own tissue is used but the disadvantages are the two-week waiting time and the second trip to the operating room.

The traditional split-thickness grafting method is also available, with a split-thickness graft of the size of the wound harvested and grafted to the wound. While this is as quick as the cell suspension technique, the traditional method gives the patient two open wounds that require healing.

The new cell suspension technique seems like a wonderful addition to the options available to both the patient and the surgeon for epidermal autografting.

 

ICD-10

Now available! FY 2020 ICD-10 Code Updates by nationally recognized coding expert Lynn Kuehn

“Anyone can read what the changes are, but truly understanding what the changes mean, why they were made, and how to ensure compliance going into FY 2020, requires a different approach.”
— Lynn Kuehn, author of the Libman Education ICD-10 CM and PCS Updates courses

About the Author

Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
Lynn Kuehn is president of Kuehn Consulting, LLC, a consulting firm specializing in coding for all settings and physician practice management issues. Lynn is a nationally recognized trainer on ICD-10-PCS and other HIM-related topics. Lynn served on the AHIMA Board of Directors and authored several of AHIMA’s most popular books including Procedural Coding and Reimbursement for Physician Services, CCS-P Exam Preparation, and ICD-10-PCS: An Applied Approach.

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