Help!

[easumma]

I billed a 15777 and Medicare denied because it did not have a primary code for it. I billed 35556, 35700, and 11043 with it but they are telling me that those codesdo not work for 15777. Can anyone tell me what code can be used for this.

 

[bethb]

Hi.

15777 would be billed for implantation of biologic implant to correct a soft tissue trauma, surgery / reinforcement. e.g. breast or trunk. I'm not sure the 3 other codes you mentioned would justify billing an implant to correct a soft tissue defect..

I've billed 15777 in conjunction with breat reconstruction, status post mastectomy for breast cancer.

 

[maryc@trgltd.com]

Skin Sub +15777

Good morning!

This code was developed by the Plastics specialty society to help define the evolving use of a variety of skin substitute (dermal and amniotic) and biologics that are used as fully implantable products to support a soft tissue repair, defect, or scaffolding.

However, the American College of Surgeons also anticipates that this code will be used to report unusual abdominal procedures (i.e. tumor removal where there's a specific defect that needs to be "filled").

In review of the codes you mention, 35556 is already a "graft" procedure. So if +15777 is to be applicable, it would need to be a separate anatomical site. Also, +35700 is already an Add-on code, and 11043 is a debridement service. I agree with the payor in that there is not a "base code" here to append +15777.

The only thing I would mention is that if the service was furnished in an office or you are responsible for reporting the facility component, I would remind you to report the skin substitute product itself (Q41**). These HCPCS are reported per sq cm, units EXPOSED (not implanted) in the operating room. Clearly, the provider is responsible for using the most appropriate available size so as to minimize waste.

Thank you, I hope you found this information helpful. Good luck.

Mary Corkins
TRG
maryc@trgltd.com