CPT codes, descriptions and other data only are copyright 2022 American Medical Association. of every MCD page. This article was converted to the new Billing and Coding Article format. Please reference the CPT descriptions for application of skin substitutes codes (Attachment C). and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only If a simple dressing change is performed without any active wound procedure as described by these codes, do not bill these codes to describe the service. The CMS.gov Web site currently does not fully support browsers with 0000006836 00000 n Debridement Debridement of subcutaneous tissue (e.g., Current Procedural Terminology (CPT) codes 11042 and 11045, if appropriate) is considered Coding Skin Procedures in the Office Setting Written and Presented by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC . cm of skin substitute application (15271). %PDF-1.5 % Code 86.69 may be assigned twice, if desired, to show the repair of the leg ulcer.. Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration 1 An asterisk (*) indicates a 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 ). 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. HLN>bE+hAi .xiJ2D4>"A_6N@f("nChK!`=x;c` DIS!Sf8_c^x)$ Before sharing sensitive information, make sure you're on a federal government site. Would also adding Mod 22 help, and for which one 11042 or 11043? An ulceration of the distal right leg was also noted and repaired with split thickness skin graft., Assign code 84.3 (revision of amputation stump) and code 86.69 (other skin graft to other sites) for the debridement and closure of the amputation site via split-thickness skin graft. 1253 0 obj <> endobj Non-human skin substitute grafts such as xenografts (from another animal such as pig) Bilateral Carpal Tunnel Procedures Different Days. Initial debridement may be deep and through skin, subcutaneous tissue, muscle fascia, and muscle. Can I report 11042 (debridement skin and subcutaneous tissue, first 20 sq cm) and +11045 (each additional 20 sq cm) for the debridement in addition to the split thickness skin graft code? Procedures involving the wrist and/or ankle are reported with codes that include arm or leg in the descriptor. Select Debridement Codes by Depth. Report these procedures, when they represent covered, reasonable and necessary services, using the CPT or HCPCS code that most closely describes the service rendered. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. 2022 HCPro, a brand of Simplify Compliance. Codify Subscriber Answer: You should [], Copyright 2023. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. 5. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. 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. ,P* &r4DH#.|QW" ss Bottom line: Accurately coding skin substitute grafts requires lots of specific information in the medical record. Reproduced with permission. 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 Answer: Not exactly. You can still separately code for deep debridement that includes muscle and bone, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington, using a code such as 11044 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq. 0000017393 00000 n 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. copied without the express written consent of the AHA. Another option is to use the Download button at the top right of the document view pages (for certain document types). 0 RyfJwE@~:_t4lGY@iYTSBd(m6 DZk0XGxmpP+pF+ff,rBQ*A-E;qkdKom`5!0>?|;!Qb5(Hj QPiX)=Zc4cgQ+*lri59? "JavaScript" disabled. MACs are Medicare contractors that develop LCDs and Articles along with processing of Medicare claims. Frequent skilled observation and assessment of wound healing are recommended daily or weekly to justify the skilled service. 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. All Rights Reserved (or such other date of publication of CPT). 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). 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. If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. Skin Substitute, Oasis wound Matrix, per square centimeter THE UNITED STATES Answer: No. 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. When other reconstructive procedure(s) (skin graft, myocutaneous flap, vessel graft . 0000011160 00000 n To bill for an Apligraf (HCPCS Q4101) package (equal to 44-sq. He is an alumnus of York College of Pennsylvania and Clemson University. Left axillary artery to left femoral artery bypass with an 8 mm PTFE graft INDICATIONS: . 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. 0000018702 00000 n 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. Youre right about the skin graft code(s). While there is some consensus that repeated debridement may promote more rapid healing of diabetic foot ulcers, the appropriate interval and frequency of debridement depends on the individual clinical characteristics of patients and ulcers. 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. If the surgeon leaves the wound open, you will report a debridement (11040-11044) rather than an excision. Wound care debridement codes 1104211047 Use these codes when the only procedure performed in wound debridement. . 0000001419 00000 n Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits 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 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. CPT Procedure Codes. pls help me whether to code manually debrided ones. 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. "JavaScript" disabled. 465 Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC Q4*`F!PZuTA~}p?sB(C0qT, "~v6C[a]o]C%%=V The AMA does not directly or indirectly practice medicine or dispense medical services. Note that debridement of the skin that is preparatory to further surgery, such as reduction of fracture, should not be coded as a separate procedure. To participate in the NAHRI forum discussions, you must be a member of the NAHRI community. (application of skin substitute graft to, for example, leg or ankle). Size: To determine the surface area for code selection, add all areas within the same anatomic grouping, if the surgeon prepares multiple wounds. endstream endobj startxref There are lessons to be learned to avoid damaging coding habits. 463 Wound Debridement & Skin Graft Except Hand, for Musculo-Connective Disorders w/ MCC 8 Diseases and Disorders of the . cm. End Users do not act for or on behalf of the CMS. endstream endobj 26 0 obj <> endobj 27 0 obj <> endobj 28 0 obj <>stream 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. article does not apply to that Bill Type. 0000016096 00000 n Include simple debridement: Skin replacement grafts include simple debridement of granulation tissue or recent avulsion. 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. The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.) All rights reserved. When subcutaneous tissue is debrided from a 16 s. cm dehisced abdominal wound and a 10 sq cm thigh wound, report 11042 for the first 20 sq cm and 11045 for the second 6 sq cm. Skin was closed with 6-0 Prolene. cm and then debridement codes (with an appropriate modifier) for the remaining 65 sq. cm or less). 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. recipient email address(es) you enter. 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. 0000008214 00000 n apply equally to all claims. In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. Trunk, arms, legs 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. These unique codes are classified as per the anatomic site (general and specific body. 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. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. A description of the procedure as excisional Per the MFSDB - payment for bilateral procedures does not apply. will not infringe on privately owned rights. 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. CMS believes that the Internet is culture and sensitivity), osteomyelitis (e.g. Coding and Billing for Skin Substitute Grafts Skin substitute graft application code selection is based on defect site location and size. 0000000936 00000 n KarenZupko & Associates, Inc. 2023 | All Rights Reserved. When can I report a debridement in addition to a graft? descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work Debridement services are now defined by body surface area of the debrided tissue and not by individual ulcers or wounds. Follow our experts tips to make sure you select the proper code and get all the pay your surgeon deserves for these services. 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 ). This method may require the surgeon to perform "staged" debridements as the wound heals. 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. The second code in each set (+15003 and +15005) are add-on codes that you should report for defect area beyond the initial size (for each additional 100 sq cm or 1 percent of body area or part thereof). We are looking for thought leaders to contribute content to AAPCs Knowledge Center. The care of minor wounds (post-operative, traumatic, or otherwise) is incidental to other covered services. In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. See CPT coding guidance for proper use of the coding. Distinguish the codes based on body site, as follows: Sometimes, a large group can make scrolling thru a document unwieldy. Subsequent debridement is often more superficial and best described by CPT codes 97597 or 97598 rather than 11043 or 11044. The Current Procedural Terminology guidelines state that debridement is considered a separate procedure "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." The views and/or positions Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. 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. 2021 Evaluation and Management Codes: Is a History Required? 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. All rights reserved. K;7@J3"(>6&/~!.]wWV~- *h"BQ"H" 5=QHpI8$ {Lz You're right about the skin graft code (s). No fee schedules, basic unit, relative values or related listings are included in CPT. Q: I have been trying to determine whether a skin graft includes debridement. 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. 1279 0 obj <>/Filter/FlateDecode/ID[<8B4464A13AA9C745B5A6304A9784D76D>]/Index[1253 57]/Info 1252 0 R/Length 97/Prev 314542/Root 1254 0 R/Size 1310/Type/XRef/W[1 2 1]>>stream 0000044306 00000 n Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. 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. Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with Q&A: Triggering PSI 15 with NG tube placement, Q&A: Defining a coders role in clinical validation, Q&A: Determine documentation difference between skin graft and debridement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. iC>:D~c~V*H0"Q%L]5CB 1. Many claims for debridement are essentially dressing changes and are not separately payable. Neither the United States Government nor its employees represent that use of such information, product, or processes U.+"x/J>DcB Examples of the inappropriate use of these codes are ulcers, furuncles, and localized skin infections. Please subscribe today or login for access. Also, you can decide how often you want to get updates. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. Local infiltration, metacarpal/digital block or topical anesthesia are included in the reimbursement for debridement services and are not separately payable. 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. cm. twZ5C2ayV`C~1S6#9mOk)d4sr$#yd:W8 Eu1EgZ \ 0 E endstream endobj 49 0 obj <>stream 0000011649 00000 n 15271-15278 is the new CPT code series for skin substitute grafts. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the These codes are primarily used when irrigation and . and monitoring is occurring. Replacement material, graft size, multiple wounds all these factors and more [], Dont miss pregnancy impact. If the provider debrides and sends samples for tissue typing to determine the appropriate depth, pathology found cartilage, is this considered 11044/bone? Q4102 . 0000002443 00000 n Supportive Documentation Requirements (required at least every 10 visits) for 97597 and 97598: Medical records must be made available to Medicare upon request. 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. Earn CEUs and the respect of your peers. Please do not use this feature to contact CMS. 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. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. Remember that the debridement codes, 11042-11047, are reported when you debride an open wound that will stay open to heal by secondary intention. {B$0{@-g;E*m ZhP' 94*_@0C"EXOeB0]:w`;d3Qf)2 }q)e]wNa%FS|C|N/\Z ZLA&0aC`+9MA- 9[cBo}gi;>E\H%2PXus |,"y5q+p^$C-y#]+vJ%@|6 : &TI=C$^';Ez^J=SZ-gZ CMS and its products and services are not endorsed by the AHA or any of its affiliates. 1 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. 5. cm or less). 3. 0000000016 00000 n Complete absence of all Revenue Codes indicates an effective method to share Articles that Medicare contractors develop. 0000010407 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. cm.). Secondary Payor Doesnt Recognize Consultations. 7500 Security Boulevard, Baltimore, MD 21244. Biological products that form a sheet scaffolding for skin growth complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. Is this right? A description of the instrument used to cut or excise the tissue (e.g., scissors, scalpel, curette) *This response is based on the best information available as of 11/16/17. /| Do not report 11042 -11047 in conjunction with 97597-97602 for the . However, we do not recommend the 11042 - 11047 codes. Any other conditions that may significantly affect wound healing should also be appropriately addressed in the medical record. Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. 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) 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. 0000004501 00000 n If all four wounds were debrided on the same day, apply modifier 59 Distinct procedural service with either 11042 or 11044, as appropriate. cm and not just that the size of the skin substitute was 20 sq. 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. 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. Incision and debridement, right knee Exchange arthroplasty liner of right total knee arthroplasty OPERATIVE NOTE: . Complete absence of all Bill Types indicates Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts.