Coding for Wound Care in 2007: Update and Changes

1. Coding for Wound Care in 2007: Update and Changes Lawrence A. Santi, DPM APMA Coding Committee Member Brooklyn, NY E-mail-ftdoc2@aol.com

2. Codes For Skin Replacement Surgery • CPT 15150-15157 • Tissue cultured epidermal autograft. • Cultured autologous skin with only an epidermal layer. • eg. CEA, Epicel, EpiDex

3. Codes For Skin Replacement Surgery • CPT 15170-15176 • Acellular dermal replacement • A tissue-derived or manufactured device that provides immediate, temp. wound closure & that incorporates into the wound and promotes the generation of a neodermis that can support epidermal tissue. • eg. Integra

4. Codes For Skin Replacement Surgery • CPT 15320-15321 • Allograft skin • Cadaveric human skin allograft. • eg, Homograft-skin from skin banks; GammaGraft.

5. Codes For Skin Replacement Surgery • CPT 15330-15336 • Acellular dermal allograft. • Decellularized allogeneic dermis may require immediate concurrent coverage with autologous tissue. • eg, Alloderm, Graft Jacket. • HCPCS code J7344.

6. Codes For Skin Replacement Surgery • CPT 15340-15341 • Tissue cultured allogeneic skin substitute. • Cultured allogeneic skin with both a dermal and epidermal layer. • eg, Apligraf, Orcel.

7. CPT 15340 & 15341 • CPT 15340 & 15341 have a 10-day global period. • Post-graft application visits are included in the reimbursement. • The HCPCS supply code for the product can be billed separately; J7340 • 15000 & Debridement codes (11040-11042) included.

8. Codes For Skin Replacement Surgery • CPT 15360-15366 • Tissue cultured allogeneic dermal substitute. • Cultured allogeneic neonatal fibroblasts. • eg, Transcyte, Dermagraft.

9. Codes For Skin Replacement Surgery • CPT 15400-15421 • Xenogeneic dermis. • Nonhuman dermis for temporary wound closure. • eg, EZ Derm, Mediskin.

10. Codes For Skin Replacement Surgery • CPT 15430-15431. • Acellular xenogeneic implant. • Decellularized nonhuman connective tissue. • eg. Oasis, Surgisis, PriMatrix.

11. CPT 15430 &15431 • CPT 15430 & 15431 have a 90-day global period. • Post-graft application visits are included in the reimbursement. (9 level II visits) • DO NOT USE MODIFIER –58. • HCPCS supply code is J7341. • CPT 15000 & Debridement codes (11040-11042) included.

12. Codes For Skin Replacement Surgery • NEW FOR 2007. • The term “surgical fixation” is eliminated! • “These codes are not intended to be reported for simple graft application alone or application stabilized with dressings (e.g., by simple gauze wrap). cont.

13. Codes For Skin Replacement Surgery cont. • “The Skin substitute/graft is anchored using the surgeon’s choice of fixation. When services are performed in the office, the supply of the skin substitute/graft should be reported separately. Routine dressing supplies are not reported separately.” • THANK YOU APMA!

14. Wound care codes NOT for Physician Use • CPT 97597 • CPT 97598 • Both formally combined under CPT 97601 • CPT 97602 • These are codes not to be used by physicians and could be subject to audit

15. Wound Care Codes NOT for Physician Use “The purpose of adding codes 97601(now replaced by 97597 & 97598) and 97602 was to describe how to report interventions associated with active wound care management, as preformed by non-physician health care providers (e.g., physical therapists, occupational therapists, and enterostomal nurses).” -CPT Assistant, May 2002

16. Wound Care Codes NOT for Physician Use • Important Note: • Many CMS Medical Directors have directed, through LCD’s, that physician’s can and should use 97597 & 97598. • CMS is not bound by the CPT, the CPT Assistant, or any other medical association interpretation. • Read your local LCD.

17. Wound Care Debridement Codes • 11040 - Debridement; Skin; Partial Thickness • 11041 - Debridement; Skin; Full Thickness • 11042 - Debridement; Skin; Full Thickness & Subcutaneous Tissue • 11043 - Debridement; Skin; Full Thickness & Subcutaneous Tissue & Muscle • 11044 - Debridement; Skin; Full Thickness & Subcutaneous Tissue, Muscle, & Bone

18. Partial Thickness – Only Epidermis

19. Full Thickness – Epidermis & Dermis

20. Full Thickness & Subcutaneous Tissue

21. Full Thickness, Subcutaneous Tissue & Muscle

22. Full Thickness, Subcutaneous Tissue, Muscle, & Bone

23. CMS & Debridement • Many CMS Medical Directors have limited the frequency of use for CPT 11043 & 11044. • Place of Service has also come into question by these CMS Medical Directors. • Read your local LCD.

24. Other Codes for Wound Care • 11000 – Debridement of extensive eczematous or infected skin; up to 10% of body surface • Typically a code used primarily for dermatological purposes • Should be used sparingly in diabetic, venous stasis, and pressure ulcers • 0 day global

25. THANK YOU