Friday, July 8, 2016

cpt code 15002, 15003, 15004, 15005

Codes For Skin Replacement Surgery

• There are new codes for “Surgical Preparation,” formally called Wound Bed Preparation.

• CPT 15000 & 15001 have been deleted.

• The new Codes are:
• 15002
• 15003
• 15004
• 15005

• CPT 15002 – Surgical Preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children.

• CPT 15003 – Each additional 100sq cm or each additional 1% of body are of infants and children.

• CPT 15004 - Surgical Preparation or creation of recipient site by excision of open wounds, burn
eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, neck ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children.

• CPT 15005 - Each additional 100sq cm or each additional 1% of body are of infants and children.


Skin Replacement (CPT codes 15002 - 15005)

1. Per the definitions and the guidelines in CPT Code Book codes CPT codes 15002/15005 are not appropriate codes to use when performing a non-surgical application of a skin substitute.

2. CPT code 15002/15005 are only appropriately used in place of service inpatient hospital, outpatient hospital or ambulatory surgical center with regional or general anesthesia to resurface  an area damaged by burns, traumatic injury or surgery. An operative report is required and must be available upon request.


Coding Guidelines

1. Active wound care, performed with minimal anesthesia is billed with either CPT code 97597 or  97598.

2. Significant debridement of a wound, performed before the application of a topical or local anesthesia is billed with CPT codes 11042 – 11047.

3. CPT codes 11043, 11046, 11044, and 11047 are usually appropriately billed in place of service inpatient hospital, outpatient hospital or ambulatory care center (ASC). Billing of these codes in another place of service is most likely a billing error and thus the service will be denied. If a  provider feels that CPT 11043, 11046, 11044, or 11047 were actually performed in another place  of service, a review of the denied claim should be requested and documentation, including an
operative report, should be submitted.

4. Use CPT codes 15271 - 15278 for the surgical preparation or creation of recipient site for the  tissue skin graft.

5. To bill for an Apligraf® (HCPCS Q4101) package (equal to 44-sq. cm.). If more than 44-sq. cm. is needed for additional grafting, bill according to the number of single units of Apligraf®, indicate Apligraf® in Item 19 of the CMS 1500 Claim Form or the Comment Field for EMC claims.

6. Payment for Apligraf® for any single ulcer will not be made for re-treatment within 1 year after initial treatment.

7. Dermagraft® (HCPCS Q4106) is supplied frozen in a clear bag containing one piece of approximately 2 in. x 3 in. (5 cm. x 7.5 cm.) for a single use application.

8. Claims submitted for skin substitutes should bill the actual size used rounding up to the next whole number.

9. When submitting a claim for skin substitutes, providers are required to accept assignment for this service. Providers, who do not accept assignment, should bill the skin product on a separate claim from other services performed on the same day.

10. Products such as Integra are classified by the Federal Drug Administration as wound dressing and are thus not payable separately by Medicare Part B for outpatient services. The application of Integra or similar FDA classified products may be payable as an inpatient for its FDA approved indication for the treatment of life-threatening full-thickness or deep partial-thickness burns.

11. For services on or after November 1, 2007, the Oasis® Wound Matrix is covered and separately payable when used according to FDA labeled indications and in accordance with accepted standards of medical/surgical practice.

12. Payable places of service for TheraSkin® (HCPCS code Q4121) if billed by the facility: outpatient hospital, (22), emergency room (23), and ambulatory surgical center (24).

13. Payable places of service for TheraSkin® (HCPCS code Q4121) if billed by the physician or nonphysician
practitioner: office (11), urgent care facility (20), and independent clinic (49).

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