Epifix Application and Debridements

bsievering

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We recently started using and billing Epifix in our wound care facilities. We use 15271 and 15272 (add on) as the application codes, with Q4131 as the product code.

Our provider was wondering if debridement codes such as 97597, 11042, 11043, or 11044 could be billed with these codes or if they were already included in the Epifix codes.

(I am not the biller for this, but was asked by a co-worker to put this question out to see what kind of responses we got.)
 

thomas7331

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Per CMS NCCI guidelines "Debridement of a skin wound (e.g., CPT codes 11000, 11042-11047, 97597, 97598) prior to a graft/skin substitute is included in the skin graft/skin substitute procedure (CPT codes 15050-15278) and should not be reported separately." NCCI does allow a modifier to unbundle the debridement from the skin substitute application as a separate procedure if a modifier (59, XE, XS, XP, XU) is supported (e.g. if the procedure is performed at a different anatomical site).
 
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bsievering

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That is along the lines of what we were thinking, but didn't want to give the provider false information. Thank you!
 
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