Skin Cell Suspension Autografts (SCSA), New CPT Codes for 2025!
This year the American College of Surgeons introduced CPT codes for the use of Skin Cell Suspension Autografts (SCSA) for the treatment of burns and full thickness skin trauma such as a degloving injury. This technique is different from a split thickness skin graft (STSG) in several ways. A traditional split thickness skin graft is harvested from the donor site and can be meshed to expand up to 2 times the harvested size. It is applied directly to the defect and anchored in place with the surgeon’s choice of fixation e.g. suture or tissue glue.
A Skin Cell Suspension Autograft can cover up to 80 times the size of the harvested tissue. This type of skin graft is harvested at a depth of 0.006-0.008 inches and processed through both enzymatic and manual disaggregation of the skin cells. Both the STSG and SCSA capture the epidermis and a portion of the dermis. The aerosolized SCSA can be aerosolized over the STSG or applied directly to the defect. Then the site is securely dressed.
Coders may see the use of a RECELL Autologous Cell Harvesting Device mentioned in the operative notes. This device allows for a skin sparing approach to harvesting tissues used in SCSA. The device was approved for use in 2018 for the treatment of acute burn injuries and in 2023 it was approved for use with full thickness skin defects occurring after trauma or surgery. It was also approved for repigmentation of stable depigmented vitiligo lesions.
There is a very detailed manual process to prepare the skin graft for SCSA application. The harvested SCSA graft is divided into sections measuring 2x3 cm., incubated in an enzyme solution for 15-20 minutes and then the surgeon removes the graft from the enzymes solution and mechanically disaggregates a small sample of the skin. If the cells separate easily they are rinsed in a buffer solution. If the cells do not come apart easily they go back into the enzyme solution for another 10 minutes. The graft is then placed on a mechanical scraping tray dermal side down and the physician scrapes the epidermal cells to completely separate the cells. The fully disaggregated cells are then rinsed with a buffer solution and gathered into a collection area. The cells are carefully drawn up into a syringe and dispensed and filtered through a cell strainer. Then they are again drawn up into a new syringe and prepared to be dispersed in aerosol form.
CPT codes 15011 and 15012 describe the harvesting of the skin used to create the cell suspension. CPT codes 15013-15014 are used to report the preparation process described above. If the harvested skin is prepared using an automated process CPT codes 15013-15014 should not be reported. CPT codes 15015-15018 are used to report the aerosolized application of the cell suspension.
The subsection guidelines in CPT were also updated to include this new technique. The guidelines clarify when to code for additional procedures, such as: “Placement of a separate additional autograft (e.g., split-thickness, full-thickness autograft) prior to application of SCSA is separately reportable with 15040-15261, as appropriate. Repair of donor site requiring skin graft or local flaps is considered a separate procedure.”
This is such a wonderful new advance in surgical care. SCSA has the ability to help severely injured patients heal faster and with less complications according to the National Institute of Health.
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