Podiatry Coding & Billing Alert

Be careful when reporting multiple wounds.

The podiatrist placed a skin substitute graft on the left foot of a patient who was badly burned in a fire. Do you know how to report this scenario?

Reporting skin grafts can be challenging because you have to know the wound’s location and site as well as the particular type of graft the podiatrist placed. Read on to learn how to submit clean skin graft claims in your podiatrist’s office.

Identify Specific Type of Skin Graft

If you peruse the “Skin Replacement Surgery” section of the CPT^® manual, you will see that the guidelines mention different types of skin grafts. When you read the podiatrist’s medical documentation, it’s very important to identify the exact type of skin graft he placed because CPT^® offers different code sets for each type of graft.

The CPT^® guidelines are very clear about what materials qualify as a skin substitute graft. Skin substitute grafts include the following:

• Non-autologous human skin (dermal or epidermal, cellular and acellular) grafts. For example, these include homografts and allografts.
• Non-human skin substitute grafts such as xenografts
• Biological products that form a sheet scaffolding for skin growth.

Don’t mix up skin graft terms: On the other hand, if you see the term “autograft” or “tissue cultured autograft,” then you are dealing with the harvest and/or application of an autologous skin graft. Autologous skin grafts are those that the podiatrist harvests from another healthy part of the patient’s own body.

Medical documentation alert: The medical documentation for skin grafts should include what size graft the podiatrist placed, how many grafts he placed, the type of grafting material he used, and how much graft material he disposed of if he did not use it all, according to Arnold Beresh, DPM, CPC, CSFAC,  in West Bloomfield, Michigan.

Rely on These Codes for Podiatry-Related Substitute Skin Grafts

When the podiatrist places a skin substitute graft for a podiatry patient’s foot or toes, you will look to the following procedure codes:

• 15275 (Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area) and +15276 (… each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure))
• 15277 (Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children) and +15278 (… each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)).

Caution: You should never report the above CPT^® codes when the podiatrist applies non-graft wound dressings such as gel, powder, ointment, foam liquid or injected skin substitutes, according to the Guidelines. The podiatrist cannot separately report these non-graft wound dressings.

Coding example: Take a look at this example from Beresh: Mr. Jones, the patient, is a 67-year-old, type 2 diabetic on Medicare. The podiatrist treated Mr. Jones for an infected wound over the dorsum of the left foot, extending from the base of the toes to the dorsal midfoot. After six weeks of antibiotic therapy and multiple debridements, the wound is now free of infection, but it has not lessened from its 6 x 6 cm size. The podiatrist decides to use a xenograft to increase the wound’s healing. On the day of surgery, the podiatrist surgically preps the wound with the use of a scalpel and forceps. He performed wound lavage and removed all nonviable tissue. Noting no exposed bone, the podiatrist applied one xenograft and secured it to the recipient site of the left foot. The podiatrist then bandaged the foot in a dry, sterile manner.

Coding solution: You would report the following codes in this situation:

• 15002 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children) for the surgical prep code
• 15277 for the graft placement
• C1763 (Connective tissue, non-human (includes synthetic)) for the graft material.​

Don’t Report 97602 in This Case

If the podiatrist removes a current graft or performs a simple cleansing of the wound, then that service is included within the skin substitute procedure codes, according to CPT^®. So, you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) for these services.

Don’t miss: CPT^® only considers debridement a separate procedure “when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.”

Podiatrist Treats Multiple Wounds? Do This

When you report codes 15271-+15278, you should choose the correct code based upon the location and size of the wound, according to CPT^®. Don’t forget to report the appropriate skin graft code based on the size of the wound surface area, not the size of the skin graft, Beresh adds.

If the podiatrist treats multiple wounds, you should sum the surface area of all the wounds from all anatomic sites that are grouped together into the same code descriptor, per CPT^®. You should not sum wounds from different groupings of anatomic sites.