Dermatology Coding Alert

Published on Wed May 10, 2006 PDF

Question: If a dermatologist were to apply an Apligraf in his office, how would we code and bill this? I know that for the Apligraf itself I should report J7340 (I assume per square centimeter). However, would there be an application charge? Also, would Medicare (Tennessee) even pay for it done in an office setting?

Tennessee Subscriber

Answer: Yes, you can bill Medicare for a bilaminate skin substitute (Apligraf) application in an office setting. For the application, report 15340 (Tissue cultured allogeneic skin substitute; first 25 sq cm or less) and +15341 (... each additional 25 sq cm) if needed.
 
Then, don't forget to report the Apligraf itself with the HCPCS code J7340 (Dermal and epidermal, [substitute] tissue of human origin, with or without bioengineered or processed elements, with metabolically active elements, per square centimeter).
 
The final step: Be sure to check with your carrier for specific qualifications. As for Tennessee's local coverage determination (Cigna Medicare), patients must have non-infected partial- and full-thickness ulcers due to venous insufficiency.
 
These ulcers must have been present for at least two months and must not have responded to conventional ulcer therapy. Read more specifics of Cigna's requirements at www.cignagovernmentservices.com/partb/lmrp_lcd/tn/cms_fu/2001-02-06.html.