I have a few Providers who have stated they are layering skin substitutes/grafts (HCPCS Q4101, Q4106, etc.) in patient's diabetic foot ulcers. Most skin substitutes are not indicated for use to layer in the ulcer or wound, however; some providers still feel it's medically necessary for the patient.

My question is, since most application codes (CPT 15365, 15340, etc.) contain the words "surface area" in their description, would you bill as follows:

Q4106 (add units as appropriate per sq cm sheets used)
15365: only up to the total sq cm's of the number of sheets used to cover the "surface" of the wound

Thanks in advance for the input!