15002 and +15003 for trunk, arms, legs (including wrist or ankle) The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. Coding Skin Procedures in the Office Setting Written and Presented by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC . PDF Coding for Wound Care - apma.org Im taking a patient to the OR for debridement of a dehiscent surgical wound and will skin graft it for closure. CPT codes 11000 and 11001 are not appropriate for debridement of a localized amount of tissue normally associated with a circumscribed lesion. an effective method to share Articles that Medicare contractors develop. Service: The work described by these codes involves preparing a clean, viable wound surface for graft placement to heal by primary intention (not secondary intention). By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. Revenue Codes are equally subject to this coverage determination. 0000020105 00000 n This Agreement will terminate upon notice if you violate its terms. Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. (application of skin substitute graft to, for example, leg or ankle). Use of CPT codes 11000-11047 is not appropriate for the following services: washing bacterial or fungal debris from feet, incision and drainage of abscess including paronychia, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. 0 Tip 3: Know Whats Included Non-excisional debridement (e.g., 97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) is described as nonsurgical because it does not involve cutting away or excising devitalized tissue. Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration Reproduced with permission. Bottom line: Accurately coding skin substitute grafts requires lots of specific information in the medical record. I work in an acute care center with a burn unit and have been striving for accuracy and consistency. %PDF-1.5 % trailer <<1D25FBD66AB6418699B8EC89A49470A5>]/Prev 196840>> startxref 0 %%EOF 74 0 obj <>stream All rights reserved. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. Q4*`F!PZuTA~}p?sB(C0qT, "~v6C[a]o]C%%=V The National Correct Coding Initiative (NCCI) bundles skin substitute graft codes 15271-+15277 with skin and subcutaneous debridement code 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less). Article - Billing and Coding: Debridement Services (A56617) The National Correct Coding Initiative (NCCI) bundles skin substitute graft codes 15271-+15277 with skin and subcutaneous debridement code 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less). Report these procedures, when they represent covered, reasonable and necessary services, using the CPT or HCPCS code that most closely describes the service rendered. Table 2 summarizes the coding matrix for the new skin substitute graft codes. cm involved a skin substitute application, you can report 15271 for the 20 sq. cm. These codes are used for wound debridement but only when you are debriding an open wound with no intention of closing it; you expect the wound to heal by secondary intention. Article document IDs begin with the letter "A" (e.g., A12345). An asterisk (*) indicates a CMS believes that the Internet is Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. Skin substitute grafts include the following: For services related to removal of callus (hyperkeratotic tissue) around an ulcer, paring or cutting of corns, trimming or debridement of nails, please refer to NGS LCD Routine Foot Care and Debridement of Nails (L33636). presented in the material do not necessarily represent the views of the AHA. of the Medicare program. Coding for skin replacement surgery in 2012 | The Bulletin hUmo0+q 0HUmIkN^D Wk$$[n;=AIWq@ hb```b``Qg`e`y @16.5&Gsf cQ"b8)l82+q {5lJ,lhn7: YZGA 3*l910eX,_ ,*KodXD78^mc0[dzMBt End User License Agreement: Debridement Debridement of subcutaneous tissue (e.g., Current Procedural Terminology (CPT) codes 11042 and 11045, if appropriate) is considered x-ray), and treatment of any infection by antibiotics. Add together the surface area of multiple . Coding Debridement Procedures - AHIMA K;7@J3"(>6&/~!.]wWV~- *h"BQ"H" 5=QHpI8$ {Lz The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. Tip 2: Identify Type of Skin Substitute Graft That means you should select the appropriate HCPCS Level II code such as Q4101 (Apligraf, per square centimeter) or C1763 (Connective tissue, non-human (includes synthetic)) for the graft material. Wound debridement is a medical procedure that removes infected, damaged, or dead tissue to promote healing. . PDF Coding Skin Procedures in the Office Setting - AAPC cm. *This response is based on the best information available as of 09/05/19. that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. Tech & Innovation in Healthcare eNewsletter, Excision of Benign or Malignant Skin Lesion, Reporting Debridement Requires Documented Area and Depth, Both Depth and Area Matter when Reporting Debridement, Meet Documentation Criteria for Excisional Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) 11042, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed) 11043, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed) 11044. v. The depth of the debridement (e.g., to skin, fascia, subcutaneous tissue, muscle, or bone). Coding Debridement with Grafts - KarenZupko&Associates, Inc. Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. Question: No fee schedules, basic unit, relative values or related listings are included in CPT. Instead, report 15273 and 15274 for the application of skin grafts of the arm, and codes 15277 and 15278 for application of skin grafts of the hands and fingers. 43 32 Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. A determination of the initial treatment plan to include the expected frequency and duration of the skilled treatment and the potential to heal. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. cm and not just that the size of the skin substitute was 20 sq. endstream endobj startxref I work in an acute care center with a burn unit and . View ICD-10-PCS CODING 2022 - Case Studies and Code Building Exercises.docx from HLTH 1241 at St. John's University. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. CDT is a trademark of the ADA. The views and/or positions Applicable FARS\DFARS Restrictions Apply to Government Use. endstream endobj startxref Non-graft wound dressings or injected skin substitute codes are not used with skin replacement surgery application codes and are considered incorrect coding. Question: 2. PDF DermaSpanTM Acellular Dermal Matrix Coding Reference Guide - Zimmer Biomet The treatment plan for a patient who requires frequent repeated debridement should be reevaluated, to ensure that pressure reduction and infection control have been adequately addressed. Answer: Debridement is considered a separately reportable procedure when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue is removed, or when debridement is carried out separately without an immediate primary closure. Tip 2: Identify Type of Skin Substitute Graft. without the written consent of the AHA. ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE, DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS, DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), Some older versions have been archived. In most instances Revenue Codes are purely advisory. No. 11010 Debridement including removal of foreign material associated with open fracture (s) and/or dislocation (s); skin and subcutaneous tissues. will not infringe on privately owned rights. Identification of the wound location, size, depth and stage either by description and/or a drawing or photograph. Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (, o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm, o Total site 100 sq cm or more: 15273 first 100 sq cm (or 1 percent body area infants and children); +15274 each additional 100 sq cm (or 1 percent body area infants and children), Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits, You can still separately code for deep debridement that includes muscle and bone, says, Grasp measurement rules. Integumentary Procedures: 3 Tips Guide Coding for Skin Substitute Grafts, 3 Tips Guide Coding for Skin Substitute Grafts, Whether the surgeon performs both steps at a single encounter or delays grafting for a later time, report the surgical preparation using codes in the range 15002-+15005 (, 15002 and +15003 for trunk, arms, legs (including wrist or ankle), 15004 and +15005 for face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, Non-autologous human skin (dermal or epidermal, cellular and acellular) grafts, including allografts (from a person other than the patient) and homografts (from cadavers), Non-human skin substitute grafts such as xenografts (from another animal such as pig), Biological products that form a sheet scaffolding for skin growth. Answer: Instructions for enabling "JavaScript" can be found here. Remember: Wound surface area is what you should consider when selecting the code, not the size of the graft, cautions Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. While every effort has been made to provide accurate and PDF Skin Substitute Grafts Coding Reference Guide - Zimmer Biomet Grasp measurement rules. 11042 - Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less + 11045 - each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 0000008118 00000 n Im looking at getting 11042 (debridement) and the skin graft codes precertified. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the If more than 44-sq. Answer: No. Some articles contain a large number of codes. Based on what I have read in the Official Guidelines for Coding and Reporting and Coding Clinic for ICD-9-CM, I believe that I should report two separate codes. You need to master the different graft options and know how to find the information in the surgeons note, because CPT includes different code sets for each type of graft. Codes 15002-15005 apply specifically to describe the work of "preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy," according to CPT guidelines. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not preparation of this material, or the analysis of information provided in the material. A description of the instrument used to cut or excise the tissue (e.g., scissors, scalpel, curette) 0000016096 00000 n Supplies such as A6453 (Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard) are included in the skin application charge. ii. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. Terms: Primary intention means that the edges of the wound or graft are closed to allow them to grow together, while secondary intention refers to allowing an open wound to heal from the base up by building new tissue. Debridement is generally associated with injuries, infections, wounds, and/or ulcers. Rather, it is removal of devitalized tissue, necrosis, and slough by other methods, including: Examples of non-excisional debridement are pulsed lavage, mechanical lavage, mechanical irrigation, high-pressure irrigation, etc. The document is broken into multiple sections. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Another option is to use the Download button at the top right of the document view pages (for certain document types). These unique codes are classified as per the anatomic site (general and specific body. As you can see, procedure code 86.69 (other skin graft to other sites) includes the debridement and closure of the amputation site via split-thickness skin graft. You can collapse such groups by clicking on the group header to make navigation easier. Please do not use this feature to contact CMS. If billed by a hospital subject to OPPS for an outpatient service, these CPT codes will be paid under the OPPS when the service is not performed by a qualified therapist and it is inappropriate to bill the service under a therapy plan of care. To participate in the NAHRI forum discussions, you must be a member of the NAHRI community. F(P.Q@/Q _(g *This response is based on the best information available as of 11/16/17. 0000002443 00000 n Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. PDF Billing and Coding Guidelines for Wound Care - Centers for Medicare A description of the type(s) of tissue involvement, the severity of tissue destruction, undermining or tunneling, necrosis, infection or evidence of reduced circulation. Biological products that form a sheet scaffolding for skin growth That means you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) in addition to skin graft site preparation codes. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. Examples of the inappropriate use of these codes are ulcers, furuncles, and localized skin infections. The physician documentation is the key to being able to support both codes. PDF Billing and Coding Guidelines - Centers for Medicare & Medicaid Services My coder says that 11043/11046 is included in 15271 and we can't separately bill for them with 15271. The AMA assumes no liability for data contained or not contained herein.