CPT codes 97597 and 97598 are categorized by CMS as sometimes therapy services. 0000006836 00000 n 0000002443 00000 n cm and Article document IDs begin with the letter "A" (e.g., A12345). The physician documentation is the key to being able to support both codes. Bottom line: Accurately coding skin substitute grafts requires lots of specific information in the medical record. *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. will not infringe on privately owned rights. Note: This question can be found in the billing and claims category on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. Examples of the inappropriate use of these codes are ulcers, furuncles, and localized skin infections. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. 7500 Security Boulevard, Baltimore, MD 21244. ii. This page displays your requested Article. Tip 3: Know Whats Included Copyright © 2022, the American Hospital Association, Chicago, Illinois. In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. If more than 44-sq. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits If you would like to extend your session, you may select the Continue Button. In cases of excessive frequency or prolonged duration of treatment, documentation should include an evaluation for possible infection (e.g. For services related to removal of callus (hyperkeratotic tissue) around an ulcer, paring or cutting of corns, trimming or debridement of nails, please refer to NGS LCD Routine Foot Care and Debridement of Nails (L33636). The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.) Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. For example: Bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer. For instance, Versajet debridement is considered to be nonsurgical, mechanical debridement because it does not involve cutting away or excising devitalized tissue. Neither the United States Government nor its employees represent that use of such information, product, or processes 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. When your surgeon treats a patient with appendicitis, you may find [], Planning can reduce consequences. No fee schedules, basic unit, relative values or related listings are included in CPT. Bill types and Revenue codes have been removed from this article. Code 86.22, Excisional debridement, was defined as the "surgical removal or cutting away of devitalized tissue, necrosis, or slough," which could be performed in the operating room, emergency room, or at the patient's bedside. Wound care debridement codes 1104211047 Use these codes when the only procedure performed in wound debridement. Initial debridement may be deep and through skin, subcutaneous tissue, muscle fascia, and muscle. I work in an acute care center with a burn unit and have been striving for accuracy and consistency. Your coder is correct simple debridement is included in the graft codes. 0000006208 00000 n There are multiple ways to create a PDF of a document that you are currently viewing. Be sure that the documentation supports that the wound area covered by the skin substitute was 20 sq. Question: Report 97597 for ulcer debridement down to the subcutaneous tissue. A description of the procedure as excisional 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. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Procedures involving the wrist and/or ankle are reported with codes that include arm or leg in the descriptor. 0000017393 00000 n A: It depends on the documentation. Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. Answer: No. 0000030507 00000 n Distinguish the codes based on body site, as follows: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. cm involved a skin substitute application, you can report 15271 for the 20 sq. 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. iC>:D~c~V*H0"Q%L]5CB 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. KarenZupko & Associates, Inc. 2023 | All Rights Reserved, Cervicocerebral Imaging Whats Included. CPT codes 11000 and 11001 describe removal of extensive eczematous or infected skin. Tip 2: Identify Type of Skin Substitute Graft. 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. endstream endobj 26 0 obj <> endobj 27 0 obj <> endobj 28 0 obj <>stream *This response is based on the best information available as of 09/05/19. Debridement is generally associated with injuries, infections, wounds, and/or ulcers. American Hospital Association ("AHA"), Reader Question: Distinguish Additional Lesion Excision Method, CCI Edits: Navigate Surgery Bundles That Could Compromise Your Pay, ICD-10 Changes: Master Guidelines for Infection, Sepsis. The objective of the procedure is to . Is this right? Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt. Addition to Skin Graft Codes 15271-15278 is the new CPT code series for skin substitute grafts. 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. 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. 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". You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Article - Billing and Coding: Debridement Services (A56617). hVmo6+ER|l%v5/:Bm#e'b|x;CA\X&V@[ ElBdd B()"8$^DHhFTDv):7^L]c"BJ#=,'$T#BJ! 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. 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. Question: [ 4"!|F. k 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. 0000018702 00000 n 2021 Evaluation and Management Codes: Is a History Required? 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. Therefore, the more accurate code is a surgical preparation code (15002 15005) for excision (note the term is not debridement) of the open wound to prepare a viable wound surface for grafting. To report these codes, the surgeons documentation should demonstrate work such as removing nonviable tissue and/or releasing a scar contracture. It's also done to remove foreign material from tissue. 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. Identification of the wound location, size, depth and stage either by description and/or a drawing or photograph. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. 43 0 obj <> endobj xref Incision and debridement, right knee Exchange arthroplasty liner of right total knee arthroplasty OPERATIVE NOTE: . What does Separate Procedure Mean in a CPT Code Description? Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. 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. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. View ICD-10-PCS CODING 2022 - Case Studies and Code Building Exercises.docx from HLTH 1241 at St. John's University. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. Codify Subscriber Answer: You should [], Copyright 2023. 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. 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.Otherwise, the graft code would have an includes note indicating the debridement is inherent in the code. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. 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. Coding and Billing for Skin Substitute Grafts Skin substitute graft application code selection is based on defect site location and size. Instructions for enabling "JavaScript" can be found here. Sign up to get the latest information about your choice of CMS topics in your inbox. 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. 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