Be Aware Of A Coding Policy Change For Cellular And Tissue-Based Products For Wounds

If you apply cellular and/or tissue-based products for wounds in your private office, it is essential that you understand how to code properly, not only for the application, but also for the product. 

The application code selection depends on the location and size of the ulcer you are treating. These application codes range from CPT 15271 to CPT 15278. The product you apply should have a “Q” code. For example, the Dermagraft (Organogenesis) Q code is Q4106 and the AmnioExcel (Derma Sciences) Q code is Q4137. You need to code both the number of units used and the number of units wasted.

Append modifier JC to the number of units used and modifier JW to the number of units wasted. Your local coverage determination (LCD) may also require appending the KX modifier to the application code as well as the codes for product used and product wasted. Until January 1, 2017, the requirement to use the JW modifier was up to your local Medicare Administrative Contractor (MAC). As of January 1, 2017, all MACs now require the use of the JW modifier.

If you are using a 5 cm² piece of AmnioExcel to cover a 4 cm² foot ulcer and wasting 1 cm², the coding should be:

15275 - KX
Q4137 4 units - JC - KX
Q4137 1 unit – JW - KX

If you are using these products in your office, be sure you are using the proper codes and proper modifiers.

Reference

1. APMA Coding Resource Center. Available at  https://www.apmacodingrc.org/home.asp

Dr. Lehrman is on the APMA Coding Committee, serves as an expert panelist on Codingline and is a Fellow of the American Academy of Podiatric Practice Management (AAPPM). Follow him on Twitter @DrLehrman.