The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. 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 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contractures ). End Users do not act for or on behalf of the CMS. Copyright © 2022, the American Hospital Association, Chicago, Illinois. Like the site preparation codes, CPT distinguishes these codes by anatomic site and wound surface area, as follows: o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm 0000000936 00000 n Absence of a Bill Type does not guarantee that the Select Debridement Codes by Depth. Any other conditions that may significantly affect wound healing should also be appropriately addressed in the medical record. 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. If you would like to extend your session, you may select the Continue Button. article does not apply to that Bill Type. HLN>bE+hAi .xiJ2D4>"A_6N@f("nChK!`=x;c` DIS!Sf8_c^x)$ Providers are reminded that the CPT code used to report the debridement must represent the level of debridement and not the depth of the ulcer. The physician documentation is the key to being able to support both codes. To bill for an Apligraf (HCPCS Q4101) package (equal to 44-sq. 0000010407 00000 n To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom To report these codes, the surgeons documentation should demonstrate work such as removing nonviable tissue and/or releasing a scar contracture. The scope of this license is determined by the AMA, the copyright holder. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential 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. 11011 skin, subcutaneous tissue, muscle fascia and muscle. endstream endobj 1254 0 obj <>/Metadata 102 0 R/OCProperties<>/OCGs[1280 0 R]>>/Outlines 119 0 R/PageLayout/SinglePage/Pages 1245 0 R/StructTreeRoot 186 0 R/Type/Catalog>> endobj 1255 0 obj <>/ExtGState<>/Font<>/Pattern<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 1256 0 obj <>stream rW`n":Q5g%_7:j)j9."QFGH(2My"hqt}%%l}]KkWmNhlI,(PjqK9%.v#|3^ya%h'e'e2iB@iFOk|q)7 If.ug q&QP;jNy>9cW=aB=je>m3/dDQMA;2VJ0E5&Qj2[iG"^l+E. 1 G/r f VY;fuC{r@,>^Q k1[1Q3#V^DJ;;j!E"&~'/;{1M, ~ B ^(\%@%t m+?Rh@yK qe<>O &j'>-3c\BMAi`/@SPPkS u6X \[bkjqkXdV41+ahqg& _p,d4ueQ@Ha s0O Tip 1: Capture Site Preparation 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. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. 0000010490 00000 n Medicare contractors are required to develop and disseminate Articles. Trunk, arms, legs The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or Complete absence of all Revenue Codes indicates F(P.Q@/Q _(g cm and CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Skin replacement surgery consists of two basic steps: surgical preparation of the recipient site and placement of the graft with fixation. Privacy Policy | Terms & Conditions | Contact Us. |S=LqO=Vz "JavaScript" disabled. Refer to NCCI and OPPS requirements prior to billing Medicare.For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.The diagnosis code(s) must best describe the patient's condition for which the service was performed. 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), o Similar code pairs based on area: 15275 and +15276; 15277 and +15278. In CPT, coding these grafts by size is a novel concept. cm.). Prior treatment by a physician, non-physician practitioner, nurse and/or therapist, Description of wound: length, width, depth, grid drawing and/or photographs, Amount, frequency, color, odor, type of exudate, Evidence of infection, undermining, or tunneling, Comorbidities (e.g., diabetes mellitus, peripheral vascular disease), Skilled plan of treatment, including specific frequency, modalities and procedures, Type of debridement performed, including instrument used, to support the debridement code billed, Changing plan of treatment based on clinical judgment of the patients response or lack of response to treatment. If all four wounds were debrided on the same day, apply modifier 59 Distinct procedural service with either 11042 or 11044, as appropriate. If the documentation supports that 20 sq. o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm 43 32 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. At a minimum, the Progress Report must document the continuing skilled assessment of wound healing as it has progressed since the evaluation or last Progress Report. CPT codes 97597 and 97598 are categorized by CMS as sometimes therapy services. not endorsed by the AHA or any of its affiliates. What are the 2020 CPT code changes? Q4*`F!PZuTA~}p?sB(C0qT, "~v6C[a]o]C%%=V "2 2a TDl.Uae9c[yd\asU/(~8}ep Q4102 . Please reference the CPT descriptions for application of skin substitutes codes (Attachment C). 15004 and +15005 for face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits Include simple debridement: Skin replacement grafts include simple debridement of granulation tissue or recent avulsion. application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) End User Point and Click Amendment: o Similar code pairs based on area: 15275 and +15276; 15277 and +15278 Addition to Skin Graft Codes. debridement of a single wound, report depth using the deepest level of tissue removed. Avoid: Dont report a skin substitute graft when the surgeon applies non-graft wound dressings such as gel, powder, ointment, foam liquid, or injected skin substitutes, according to the guidelines. If any of these elements is missing, documentation does not meet the criteria for excisional debridement. . Add skin substitute: When your surgeon performs a skin substitute graft, the supply of the skin substitute/ graft should be reported separately, according to CPT instruction. iC>:D~c~V*H0"Q%L]5CB 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) You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Be sure that the documentation supports that the wound area covered by the skin substitute was 20 sq. 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. Tip 2: Identify Type of Skin Substitute Graft The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. A description of the type(s) of tissue involvement, the severity of tissue destruction, undermining or tunneling, necrosis, infection or evidence of reduced circulation. 1 cm, equal to, or greater than 100 sq. To participate in the NAHRI forum discussions, you must be a member of the NAHRI community. Sometimes, a large group can make scrolling thru a document unwieldy. 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. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. If the provider is unable to use photographs for documentation purposes, the medical record should contain sufficient detail to determine the extent of the wound and the result of the treatment. If the documentation supports that 20 sq. Skin Lesion Excision Wait for Pathology? 0000010293 00000 n 0000001419 00000 n 0000012252 00000 n The AMA is a third party beneficiary to this Agreement. For patients with chronic wounds being treated in an outpatient setting, services beyond the fifth surgical debridement, CPT code 11043, 11046 and/or 11044, 11047, per patient, per year, per wound may require a medical review of records demonstrating the medical reasonableness and necessity. In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. *4 Use CPT code 15340-15341 or CPT code 15360-15366 for the surgical preparation or creation of recipient site for the tissue skin graft. endstream endobj 26 0 obj <> endobj 27 0 obj <> endobj 28 0 obj <>stream Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt. appropriate codes to use when performing a non-surgical application of a skin substitute. 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. You can use the Contents side panel to help navigate the various sections. Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Copyright 2023, AAPC However, we do not recommend the 11042 11047 codes. . Include cleaning: When the surgeon performs a simple cleansing of the wound, that service is included within the skin substitute procedure codes, according to CPT instruction. 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. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. Your MCD session is currently set to expire in 5 minutes due to inactivity. cm and not just that the size of the skin substitute was 20 sq. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. presented in the material do not necessarily represent the views of the AHA. A description of the procedure as excisional CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. 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.