Wiki 15002 Frequency help

[heatherposchman1]

In the CPT section guidance, it states "Surgical preparation may be reported only once per wound". I am coding 15002 at every Allograft application, of the same wound. The documentation is clear that the wound was debrided of residual graft tissue and stimulated granular tissue to optimize wound bed for application of allograft and promote granulation of tissue. Is the "once per wound" each time it's performed OR once per wound location?? I cannot find any further guidance on this and need clarification.

 

[Orthocoderpgu]

In the CPT section guidance, it states "Surgical preparation may be reported only once per wound". I am coding 15002 at every Allograft application, of the same wound. The documentation is clear that the wound was debrided of residual graft tissue and stimulated granular tissue to optimize wound bed for application of allograft and promote granulation of tissue. Is the "once per wound" each time it's performed OR once per wound location?? I cannot find any further guidance on this and need clarification.

Code 15002 has an MUE of one. Only one per day would be allowed.

 

[podcoder70]

You are using the wrong code. Prior to application of allograft, on a separate visit date, bill the "prep" code 15002 for ankle and 15004 for foot. On the visit you plan on applying the allograft, bill the application code 15271 for ankle and 15275 for foot. The "prep" code should only be used once per wound. If application were terminated because the wound became infected, the prep code could be billed again on that same wound prior to beginning application again. The prep and application code should not be billed together on the same day and the prep code should not be billed with the allograft nor if there is no plan to apply tissue or a tissue sub.

 

[heatherposchman1]

You are using the wrong code. Prior to application of allograft, on a separate visit date, bill the "prep" code 15002 for ankle and 15004 for foot. On the visit you plan on applying the allograft, bill the application code 15271 for ankle and 15275 for foot. The "prep" code should only be used once per wound. If application were terminated because the wound became infected, the prep code could be billed again on that same wound prior to beginning application again. The prep and application code should not be billed together on the same day and the prep code should not be billed with the allograft nor if there is no plan to apply tissue or a tissue sub.

Thank you! I am still trying to get a better understanding so I have a few questions.

For a nonhealing wound of the leg, typically the physician debrides the wound site and then applies the allograft to the leg at the same visit. We are billing 15002/15271. The patient patient returns weekly and the the procedure is repeated and the 15002/15271 is again billed for the that day and so on. Since 15002 and 15271 do not bundle, why should they not be billed together on the same day? My initial question was in regard to billing the "prep" code at each visit since the description states once per would. In many instances, the same procedure is performed every week on the patient until the woild no longer equires an allograft. Are we billing this wrong and can you explain whay? THANK you in advance for you input.

"

 

[podcoder70]

Thank you! I am still trying to get a better understanding so I have a few questions.

For a nonhealing wound of the leg, typically the physician debrides the wound site and then applies the allograft to the leg at the same visit. We are billing 15002/15271. The patient patient returns weekly and the the procedure is repeated and the 15002/15271 is again billed for the that day and so on. Since 15002 and 15271 do not bundle, why should they not be billed together on the same day? My initial question was in regard to billing the "prep" code at each visit since the description states once per would. In many instances, the same procedure is performed every week on the patient until the woild no longer equires an allograft. Are we billing this wrong and can you explain whay? THANK you in advance for you input.

"

The code 15271 and similar have a wound prep and debridement factored into the application, thus, billing 15002 at the same visit is not appropriate and it should only be billed once per wound. When it is determined that the patient would benefit from skin sub, the wound prep would be performed (15002/3 ankle/leg and 15004/5 foot) and the prep code is billed. The patient then returns for the application of the skin sub or allograft on a subsequent visit and the application code as well as the product code is billed. CMS has an LCD for skin substitutes, pull that for your MAC. It is very specific about documentation as well as how many grafts are appropriate. Within the LCD, under "Limitations" it states
1. Use of surgical preparation services in conjunction with routine, simple and/or repeat application of skin substitute grafts is not reasonable and necessary and will be denied accordingly.
2. Most repeat applications of skin replacement materials will not require separate debridement procedures. Such procedures may be subject to pre or post payment medical review. If documentation does not support cross contamination requiring extended cleansing and removal of appreciable amounts of devitalized tissue was performed, the service will be denied.
3. Clean and free of necrotic debris or exudate

 

[heatherposchman1]

The code 15271 and similar have a wound prep and debridement factored into the application, thus, billing 15002 at the same visit is not appropriate and it should only be billed once per wound. When it is determined that the patient would benefit from skin sub, the wound prep would be performed (15002/3 ankle/leg and 15004/5 foot) and the prep code is billed. The patient then returns for the application of the skin sub or allograft on a subsequent visit and the application code as well as the product code is billed. CMS has an LCD for skin substitutes, pull that for your MAC. It is very specific about documentation as well as how many grafts are appropriate. Within the LCD, under "Limitations" it states
1. Use of surgical preparation services in conjunction with routine, simple and/or repeat application of skin substitute grafts is not reasonable and necessary and will be denied accordingly.
2. Most repeat applications of skin replacement materials will not require separate debridement procedures. Such procedures may be subject to pre or post payment medical review. If documentation does not support cross contamination requiring extended cleansing and removal of appreciable amounts of devitalized tissue was performed, the service will be denied.
3. Clean and free of necrotic debris or exudate

Thank you VERY much for that clarification, I will pull the LCD and review it further.