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Apligraf placement

  1. #1
    Default Apligraf placement
    Medical Coding Books
    If the doctor does not suture the Apligraf but applies a wrap to hold the graft in place can you still code out a 15340 for the placement?

  2. #2
    Phoenix, AZ
    Hi there,

    I code wound care for our OP clinic. I have never seen documentation for Oasis, dermagraft or Apligraf with a wrap instead of sutures. Here is an excerpt from the LCD from Noridian, "For coverage of skin substitute products (devices) subject to Noridians Application of Skin Substitutes LCD, a product will be considered as a graft if the product is intended:
    1) at the time of application to fully replace lost tissue, and

    2) to achieve closure of a wound (whether in fact it is successful is not a firm criterion upon which payment would be based)

    The expectation is that the product itself will function as a permanent replacement for the lost or damaged skin.

    On the other hand, if the product is intended to achieve temporary closure or coverage of the wound, or to act as a matrix or scaffolding that encourages and/or otherwise supports the ingrowth of the patients own tissues in order to achieve permanent wound closure, we will not consider that use as a graft. Application of products, which warrant routine and/or anticipated replacement would be - at best - wound dressings, not grafts."

    The LCD number is L24273 if you want to check it out for yourself.

    I would want to make sure there is documentation as to why there are no sutures being used for the graft.

    Hope this helps you,
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  3. #3
    The CPT guidelines for Surgery/Integumentary System says " The codes are not intended to be reported for simple graft application alone or application stabilized with dressings (eg, by simple guze wrap)"

  4. #4
    Default Thanks
    For whatever reason the provider is using compression stockings/wrappings to hold the graft in place. Thanks for your responses!

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