Porcine Graft billing to Medicare

[Jen Verlinda]

Hi everyone,

I'm in Wa State and recently received a denial from Medicare for the Porcine Graft repair my MD performed post Moh's. I am finding that the problem Medicare is having may or may not be directly related to the new codes. Prior to 2012, the code used to capture this procedure would have been 15420. The new codes listed are 15275-15278. I billed a 15275, "application of skin substitue graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits total would surface area up to 100 sq cm". The only LCD that the Medicare rep found for this 15275 code was LCD# 24273, which for some apparent reason does not capture any of the diagnoses codes for skin cancer, in fact the only diagnoses codes captured under this LCD pertain to diagnoses of lower extremity conditions only. I find this odd, since the 15275 code applies to many anatomical locations, not just dx codes of the lower extremity.

Is anyone else experiencing this problem? And if so, how are you getting reimbursed in 2012 for porcine graft billing?

Any input on this would be greatly appreciated.

Thank you,

Jen Verlinda, CPC
Account Manager
Pacific Dermatology & Cosmetic Center

[jholt12]

Hi,
I live in CA and have billed the new porcine graft codes and they have been paid. I'm not sure if it is the state of WA or not. Also with that code you can now bill for the porcine skin that you are using. It is an unlisted code Q4100. Not that helps you since your having problems getting the other code paid but I just wanted to throw that out there for you.
Hope it all works out.

Thanks,
Julia

[jcansler]

Hi Jen,

I am also in Washington state and encountered the same problem. There is a thread for my question posted 02/01/12 if you search for 15275 that includes the information you are looking for. Basically, Noridian Medicare does not cover the skin substitute codes for any diagnosis other than ulcers.