15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

The CPT code 15100 describes the surgical harvest and application of a split-thickness skin autograft to reconstruct defects on the trunk, arms, or legs, encompassing a total area up to the first 100 square centimeters in adults, or up to 1 percent of the total body surface area in infants and children. A split-thickness skin graft (STSG) involves the harvest of the entire epidermis and a variable portion of the underlying dermis from a healthy donor site on the patient's own body. This procedure is a cornerstone in reconstructive surgery, utilized to cover substantial integumentary defects resulting from thermal or chemical burns, extensive traumatic avulsions, major surgical resections (such as wide excisions for cutaneous malignancies), or refractory chronic wounds like venous stasis ulcers that cannot heal by secondary intention. The surgical process begins with the meticulous preparation of the recipient bed, which must consist of healthy, well-vascularized tissue free of infection and necrotic debris to ensure optimal graft survival (recipient site preparation is typically coded separately). Using a specialized surgical instrument called a dermatome, the surgeon precisely shaves the split-thickness layer of skin from a selected donor site, commonly the anterior thigh, lateral thigh, or buttocks. Once harvested, the graft may be passed through a skin meshing device. Meshing places multiple small slits in the graft, allowing it to expand to cover a larger surface area and creating fenestrations that facilitate the drainage of underlying blood and exudate, thereby preventing hematoma or seroma formation that could compromise graft adherence. The graft is carefully positioned over the recipient defect, trimmed to fit, and secured into place using absorbable or non-absorbable sutures, surgical staples, or fibrin sealants. To maximize graft-to-bed contact and minimize shearing forces, a bolster dressing, negative pressure wound therapy (wound VAC), or a specialized pressure dressing is applied over the graft. Concurrently, the donor site is treated with hemostatic agents and covered with a non-adherent dressing to promote rapid re-epithelialization. Code 15100 strictly applies to the trunk, arms, and legs; coverage of cosmetically or functionally sensitive areas such as the face, hands, feet, or genitalia requires alternative CPT codes.

Clinical Indications

  • Full-thickness or deep partial-thickness burn wounds requiring skin grafting for closure.
  • Extensive traumatic avulsions or degloving injuries involving the trunk, arms, or legs.
  • Large surgical defects following the excision of benign or malignant cutaneous neoplasms, such as melanoma or squamous cell carcinoma.
  • Chronic, non-healing cutaneous ulcers (e.g., venous stasis ulcers, diabetic foot ulcers extending to the leg) that have failed conservative therapy.
  • Reconstruction following the debridement of necrotizing soft tissue infections, such as necrotizing fasciitis.
  • Coverage of exposed granulation tissue resulting from previous graft failure or extensive trauma.

Procedure Steps

  1. The patient is appropriately positioned and administered local, regional, or general anesthesia depending on the extent of the defect and harvest site.
  2. Both the recipient site and the selected donor site (often the thigh or buttock) are prepped and draped in a sterile fashion.
  3. The recipient wound bed is assessed to ensure it is healthy, well-vascularized, and free of necrotic tissue (excision or debridement is performed and reported separately if required).
  4. A dermatome is calibrated to the desired graft thickness and used to harvest the split-thickness skin graft from the donor site.
  5. The harvested graft is optionally passed through a skin mesher to expand its surface area and provide drainage fenestrations.
  6. The graft is transferred to the recipient site, properly oriented, and tailored to fit the precise dimensions of the defect.
  7. The graft is secured to the wound margins and bed using surgical staples, sutures, or tissue adhesives.
  8. A bolster dressing or negative pressure wound therapy (NPWT) device is applied over the graft to apply uniform pressure, prevent fluid accumulation, and immobilize the graft against sheer forces.
  9. The donor site is dressed with a non-adherent, absorptive dressing to facilitate hemostasis and secondary healing.

Coding Guidelines

  • Report 15100 for split-thickness autografts applied to the trunk, arms, and legs for the first 100 sq cm or less.
  • Use add-on code 15101 for each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof. List 15101 separately in addition to the primary procedure code 15100.
  • Do not report 15100 with 15050 (pinch graft).
  • Surgical preparation of the recipient site (excision of open wound, burn eschar, or scar) is reported separately using codes 15002-15005.
  • For split-thickness autografts applied to the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, use codes 15120 and 15121 instead of 15100.
  • The measurement of the graft should be based on the size of the recipient defect area, not the size of the harvested donor graft.
  • Routine dressing of the donor site is included in 15100 and should not be reported separately.
  • If negative pressure wound therapy (NPWT) is applied to the graft site, check payer policies to determine if NPWT placement is separately reportable or bundled into the graft procedure.

Associated ICD-10 Codes