Wiki Apligraf and MCR

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solocoder

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springfield, MO
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Recently we billed MCR:
G0440
Q4101
11042

Can someone tell me why MCR would have denied the G0440 (application) as "payment included in SX prodecure?"? It IS the SX procedure.
NCCI edits do not show it as being bundled with Q4101 or 11042. And according to WPS, 11042 IS allowed with this graft.
 
This is the language from the LCD (L24273) - Application of Bioengineered Skin Substitutues

9. Providers should note that CPT 2011 includes a parenthetical statement following codes 15340 and 15341, as follows:
“(Do not report 15340, 15341 in conjunction with 11042, 15002-15005).” Even though 15340 and 15341 are supplanted
for Medicare coding purposes by G0440 and G0441 which contain no similar restrictive language, NAS believes that it is
appropriate to follow the same logic for these G-codes as for 15340 and 15341. These debridement codes will be denied
if used in conjunction with G0440 or G0441.

Hope that helps,
 
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