Part B Insider (Multispecialty) Coding Alert

Published on Thu Nov 03, 2005 PDF

Try creating a "cheat sheet" to safeguard your reimbursement

CPT 2006 takes a leap to catch up with new skin-graft technologies--and now you need to jump to keep up.

Next year's coding manual adds 37 new skin graft codes and deletes four. It also renames the skin grafts section "Skin Replacement Surgery And Skin Substitutes." (See PBI, Vol. 6, No. 38.)

The codes seem designed to represent some new techniques and procedures, says Teresa Thompson with TM Consulting in Sequim, WA. They include new codes for autografts (15100-15261), allografts (15170-15176) and xenografts (15400-15431)--and many of the codes are specific to particular products or technologies.

Until now, you have struggled to get paid for some of these expensive and specialized products using a general skin graft code, notes John Bishop, president of Bishop & Associates in Tampa, FL. These include products such as Dermagraft, Integra, Appligraft and Biobrane.

Important: But now that you have codes for the products you're already using, it's doubly important to choose the right code, Bishop adds. Pay attention to both the composition of the synthetic product and the amount, he advises. Many of the new codes cover the first 100 cm and then include an add-on code for each additional 100 cm.

Smart idea: Put a list of products and corresponding codes on your cheat sheet or superbill, Bishop advises. That way your coders can easily assign the correct code to  each product.

There's also a new code for harvesting skin for an autograft (15040). In the past, providers had to use a biopsy code to bill for skin-harvesting, and many payors wouldn't reimburse that code, Bishop relates.

Another tip: If your physician uses AlloDerm, then you need to think bigger. In the past, you would have billed 15342 for the first 25 cm, and 15343 for each additional 25 cm. But now, you'll use CPT 15170 , which covers the first 100 cm by itself. It's common to use AlloDerm to treat small burns and ulcers,  says Bishop.