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Apligraf and MCR

  1. #1
    Springfield, Mo
    Question Apligraf and MCR
    Medical Coding Books
    Recently we billed MCR:

    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.

  2. #2
    Phoenix, AZ
    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,
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

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