How To Get Optimal Reimbursement For Wound Debridement And Skin Substitutes

Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

These knowledgeable panelists provide insights on using appropriate codes for wound debridement and skin substitutes to maximize reimbursement. They also address the correct use of modifiers and offer coding pearls for those entering practice.

Q:

What is the right way to bill for wound debridement in the office and in the OR?

A:

For wound debridement, Anthony Poggio, DPM, suggests describing the wound, appearance, odor, wound base and surrounding inflammation/infection as well as the size of the wound both pre- and post-debridement. He says one should be very specific and document the tissue actually debrided. Dr. Poggio adds that the fact that the wound goes to muscle does not automatically imply that one debrided muscle. He says podiatrists should add up the aggregate size of all similar wounds (based upon the type of tissue debrided).

   Similarly, Kazu Suzuki, DPM, adds that last year, CPT codes changed to reflect the wound surface area that one debrided in 20 cm2 increments.

   “The rule of thumb is the debridement depth level is based on what you remove and not what you see,” he says. While one may often see bone or tendon in a wound, Dr. Suzuki says podiatrists should code for 11042 (subcutaneous level debridement) if they are only removing subcutaneous tissues.

   Barbara Aung, DPM, encourages podiatrists to know the appropriate codes for the appropriate level of debridement and how to calculate wound area for the appropriate skin substitute code.

   “With the current focus on wound care and post-payment reviews, proper documentation is of utmost importance,” notes Dr. Aung. “Being able to meet medical necessity so the documentation supports what is billed is the key to keeping the reimbursement you have earned for the services you have performed.”

   In addition, Dr. Poggio suggests documenting the use of anesthesia if applicable and documenting the type of instrumentation one utilized.

Q:

How do you code for skin substitute applications?

A:

As Dr. Suzuki notes, CPT codes for skin substitutes changed drastically in 2012. He explains that the new series of skin substitute codes is based on the anatomic location as opposed to which products (i.e. Dermagraft, Graftjacket) are in use while DPMs still receive reimbursement for the product based on the Q code. Dr. Suzuki says those codes are now uniform with skin graft codes, and are anatomically separated in two areas, CPT 15271 for the body (trunk, arms, legs) and CPT 15275 for extremities (hands, feet including heels). Similar to wound debridement, the skin substitute codes are coded based on increments of 25 cm2, according to Dr. Suzuki.

   Dr. Aung says one should bill all “skin substitute” applications using the same set of codes regardless of the product. She says one should select the code based on the total area of the ulcer/wound and the site of skin substitute application. Dr. Aung adds that one may separately report the supply of the actual product (the skin substitute graft itself) using a HCPCS II supply code by the provider that incurred the expense. Dr. Poggio adds that one may bill for both the graft material and the application of that material.

   For example, Dr. Aung says one should report the application of a 25 cm2 allograft to a foot with code 15275. Report each subsequent 25 cm2 allograft up to 100 cm2 with the add-on code +15276. Therefore, one would report a 42 cm2 allograft application to a foot with two codes: 15275 and +15276, according to Dr. Aung.

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