Coding for Wound Care in 2007: Update and Changes

Lawrence A. Santi, DPMAPMA Coding Committee Member

Brooklyn, NYE-mail-ftdoc2@aol.com

Codes For Skin Replacement Surgery

• CPT 15150-15157

• Tissue cultured epidermal autograft.

• Cultured autologous skin with only an epidermal layer.

• eg. CEA, Epicel, EpiDex

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

Codes For Skin Replacement Surgery

• CPT 15320-15321

• Allograft skin

• Cadaveric human skin allograft.

• eg, Homograft-skin from skin banks; GammaGraft.

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.

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.

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.

Codes For Skin Replacement Surgery

• CPT 15360-15366

• Tissue cultured allogeneic dermal substitute.

• Cultured allogeneic neonatal fibroblasts.

• eg, Transcyte, Dermagraft.

Codes For Skin Replacement Surgery

• CPT 15400-15421

• Xenogeneic dermis.

• Nonhuman dermis for temporary wound closure.

• eg, EZ Derm, Mediskin.

Codes For Skin Replacement Surgery

• CPT 15430-15431.

• Acellular xenogeneic implant.

• Decellularized nonhuman connective tissue.

• eg. Oasis, Surgisis, PriMatrix.

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.

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.

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!

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

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

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.

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

Partial Thickness – Only Epidermis

Full Thickness – Epidermis & Dermis

Full Thickness & Subcutaneous Tissue

Full Thickness, Subcutaneous Tissue & Muscle

Full Thickness, Subcutaneous Tissue, Muscle, & Bone

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.

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

THANK YOU