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. 0000006208 00000 n Distinguish the codes based on body site, as follows: Each pair of codes identifies the size of the defect created by the surgical preparation, with the first code (15002 or 15004) describing the first 100 sq cm for adults and children aged 10 and up, or 1 percent of body surface area for children under 10 years of age, including infants. Tip 2: Identify Type of Skin Substitute Graft. 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. Youve learned that you can separately report the site preparation and the skin substitute graft placement procedures, but you may wonder what other services and materials in the op report are separately billable. Subsequent debridement is often more superficial and best described by CPT codes 97597 or 97598 rather than 11043 or 11044. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Also, you can decide how often you want to get updates. These unique codes are classified as per the anatomic site (general and specific body areas) and size (wounds with a total surface area less than 100 sq. Two procedure codes need to be assigned-the excision and the graft closure. j0 W0 Tip 3: Know Whats Included The document is broken into multiple sections. The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.) without the written consent of the AHA. Skin substitute grafts include the following: 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. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. 0000001419 00000 n All Rights Reserved. cm and then debridement codes (with an appropriate modifier) for the remaining 65 sq. Current Dental Terminology © 2022 American Dental Association. An operative note or procedure note for the debridement service. 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. cm involved a skin substitute application, you can report 15271 for the 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. 2021 Evaluation and Management Codes: Is a History Required? Frequent skilled observation and assessment of wound healing are recommended daily or weekly to justify the skilled service. Another option is to use the Download button at the top right of the document view pages (for certain document types). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Debridement of diabetic foot ulcers more frequently than once every seven (7) days, for a period longer than three (3) months may not be reasonable and necessary. Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 100 up to 200 sq Coding Skin Procedures in the Office Setting Written and Presented by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC . This method may require the surgeon to perform "staged" debridements as the wound heals. ii. If infection has developed, the patient's response to this infection should be described. Table 2 summarizes the coding matrix for the new skin substitute graft codes. The AMA does not directly or indirectly practice medicine or dispense medical services. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. For example: Bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer. Secondary Payor Doesnt Recognize Consultations. For example, debridement of two ulcers on the foot to the level of subcutaneous tissue, total area of 6 sq cm should be billed as CPT code 11042 with unit of service of "1". John Verhovshek, MA, CPC, is a contributing editor at AAPC. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. hbbd``b`uw@D`9$-$:@3AJT,$ fdgX*0L@6b``,O M End User License Agreement: CPT codes 11000 and 11001 describe removal of extensive eczematous or infected skin. 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. Services exceeding this intensity and duration of treatment will be considered not medically necessary. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. hbbd``b`J@ H0lV$ W0 y iC>:D~c~V*H0"Q%L]5CB appropriate codes to use when performing a non-surgical application of a skin substitute. Anesthesia administered by or incident to the provider performing the debridement procedure is not separately payable. All rights reserved, CMS publishes FAQ on modifiers -JW and -JZ, 2023 Revenue Integrity Symposium Justification Letter, 2023 NAHRI Leadership Council participation requirements, 2023 NAHRI Leadership Council research survey released. 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. 6. Follow our experts tips to make sure you select the proper code and get all the pay your surgeon deserves for these services. All rights reserved. Skin Substitute, Oasis wound Matrix, per square centimeter Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. KarenZupko & Associates, Inc. 2023 | All Rights Reserved, Cervicocerebral Imaging Whats Included. will not infringe on privately owned rights. Skin Lesion Excision Wait for Pathology? In addition to the type of graft material, the surgeon should also document site preparation and wound size, and number and location of grafts, according to Beresh. Q4*`F!PZuTA~}p?sB(C0qT, "~v6C[a]o]C%%=V This note should describe the anatomical location treated, the instruments used, anesthesia used if required, the type of tissue removed from the wound, the depth and area of the wound and the immediate post procedure care and follow-up instructions. 8u-0=*.tCOeF8h`TLeHRzLco`@X(d9rFdcG VA,P&l Incision and debridement, right knee Exchange arthroplasty liner of right total knee arthroplasty OPERATIVE NOTE: . Include simple debridement: Skin replacement grafts include simple debridement of granulation tissue or recent avulsion. Examples of the inappropriate use of these codes are ulcers, furuncles, and localized skin infections. Secondary Payor Doesnt Recognize Consultations. "JavaScript" disabled. qe<>O &j'>-3c\BMAi`/@SPPkS u6X \[bkjqkXdV41+ahqg& _p,d4ueQ@Ha s0O A determination of the initial treatment plan to include the expected frequency and duration of the skilled treatment and the potential to heal. 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. 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. 0000044306 00000 n I work in an acute care center with a burn unit and have been striving for accuracy and consistency. . preparation of this material, or the analysis of information provided in the material. Earn CEUs and the respect of your peers. When the patient has required more debridement services per wound than defined below, the medical record must include documentation reflecting neuropathic, vascular, metabolic, or other comorbid conditions. 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. Supportive Documentation Requirements (required at least every 10 visits) for 97597 and 97598: Medical records must be made available to Medicare upon request. Answer: No. Add together the surface area of multiple . An official website of the United States government. 0000010490 00000 n 465 Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC 573 Skin Graft for Skin Ulcer or Cellulitis with MCC Skin substitute grafts include the following: 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. Select Debridement Codes by Depth. Absence of a Bill Type does not guarantee that the 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. 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). 1. These codes are primarily used when irrigation and . 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) f-\n`Js^7u_p9X-WEpWio.@C6I@|V5J]5q;@OXAi*##C#YL,3+Ol]8t~{kR[.){l+-{AIe^\0(IA%ju~qy=(*FZ> l9a|ZJ>}*:2 {GI5|hV\)f#a43eEMM0s Coding and Billing for Skin Substitute Grafts Skin substitute graft application code selection is based on defect site location and size. Coding matrix for the new skin substitute graft codes For multiple wounds, sum the surface area of all wounds requiring grafts from the same anatomic site and report the applicable primary code and add-on code in multiples, as appropriate. 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). 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 You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. 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. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. If you miss the separate skin preparation step, youll sacrifice pay your surgeon deserves. "2 2a TDl.Uae9c[yd\asU/(~8}ep Any other conditions that may significantly affect wound healing should also be appropriately addressed in the medical record. The AMA is a third party beneficiary to this Agreement. cm and Question: Sometimes, a large group can make scrolling thru a document unwieldy. K;7@J3"(>6&/~!.]wWV~- *h"BQ"H" 5=QHpI8$ {Lz You're right about the skin graft code (s). 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 Many claims for debridement are essentially dressing changes and are not separately payable. 1 39 0 obj <>stream If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. When your surgeon treats a patient with appendicitis, you may find [], Planning can reduce consequences. The page could not be loaded. The following procedures are considered part of active wound care management, and are not considered as debridement and are not included in the related LCD: Removal of devitalized tissue from wound(s), non - selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care. Im looking at getting 11042 (debridement) and the skin graft codes precertified. 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). Code Debridement by Documented Depth and Area When reporting debridement of a bedsore, code selection depends on the depth of debridement and total area debrided: Depth to subcutaneous tissue (to the depth of blood vessels and nerves): 11042 (first 20 sq cm) and +11045 (each additional 20 sq cm, or part thereof) cm. 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. Replacement material, graft size, multiple wounds all these factors and more will come into play when youre coding a skin replacement surgery using skin substitute grafts for conditions such as burns. Distinguish the codes based on body site, as follows: Debridement Debridement of subcutaneous tissue (e.g., Current Procedural Terminology (CPT) codes 11042 and 11045, if appropriate) is considered pls help me whether to code manually debrided ones. To code the excision, look in the index for the term Lesion, then Skin. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. If more than 44-sq. In your example, you will be closing the wound. x-ray), and treatment of any infection by antibiotics. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom that coverage is not influenced by Bill Type and the article should be assumed to A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. 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. I performed a simple debridement with a full thickness graft of the trunk and reported 15200 and coded also for the debridement, but my coder told me I could not report the debridement. 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 CPT is a trademark of the American Medical Association (AMA). 4. 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) CPT considers debridement a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.. He is an alumnus of York College of Pennsylvania and Clemson University. 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. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. an effective method to share Articles that Medicare contractors develop. Im taking a patient to the OR for debridement of a dehiscent surgical wound and will skin graft it for closure. 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. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. 0000016569 00000 n CPT considers debridement a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure. Answer: cm or less). To bill for an Apligraf (HCPCS Q4101) package (equal to 44-sq. and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only 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. In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. This article was converted to the new Billing and Coding Article format. jQuery(function() { _initLayerSlider( '#layerslider_57_r6v94to757da', {createdWith: '6.8.2', sliderVersion: '6.9.2', allowFullscreen: true, pauseOnHover: 'enabled', skin: 'v6', sliderFadeInDuration: 350, useSrcset: true, skinsPath: 'https://karenzupko.com/wp-content/plugins/LayerSlider/assets/static/layerslider/skins/', performanceMode: true}); }); KarenZupko & Associates, Inc. 2023 | All Rights Reserved. endstream endobj startxref Applicable FARS\DFARS Restrictions Apply to Government Use. 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. In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. Copyright 2023 HCPro, a Simplify Compliance brand. hVmo6+ER|l%v5/:Bm#e'b|x;CA\X&V@[ ElBdd B()"8$^DHhFTDv):7^L]c"BJ#=,'$T#BJ! Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, R'7bd snYJ@ 9PE@ cL endstream endobj 44 0 obj <>>> endobj 45 0 obj >/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/Tabs/W/Thumb 35 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 46 0 obj [/ICCBased 68 0 R] endobj 47 0 obj <> endobj 48 0 obj <>stream culture and sensitivity), osteomyelitis (e.g. The views and/or positions presented in the material do not necessarily represent the views of the AHA. Please subscribe today or login for access. Identification of the wound location, size, depth and stage either by description and/or a drawing or photograph. H|Wd5W5Re'c X!XFk4K|?>_/]%zWCBJ7 .`u}}`JWJz=^o\z9e~BT AT9 vqdYkh%BprY-.%V)["[n . I96w4Ak1;*8LMZI;Oe1\s &$W2DQY#"E"2$*85lm"HIl]JW)"4#F3^6F8?1HtaG]xuA*D::!83P|MnKC*{:?qk,nlG,d=atI'0 I2nC cm or less). Federal government websites often end in .gov or .mil. Q4102 . All rights reserved, Debridement of the skin that is preparatory to further surgery such as reduction of fracture, etc., should not be coded as a separate procedure., The surgeon debrided the necrotic tissue surrounding the amputation site, harvested skin from the patient's thigh and closed the wound with a split thickness skin graft.