Please provided guidance or confirmation on the appropriate CPT codes when applying a biological wound skin graft substitute. I understand when this type of skin substitute graft is applied in the office that the appropriate HCPCS code for the graft and the number of units based on the brand name and size must be billed. Then, I understand that CPT code for application of a skin substitute graft: 15271-78 categorized by wound graft size and anatomical site. But should the CPT code 15002-15005 which describe the work of preparing a clean and viable wound surface for placement of the graft as well?
Also, can you bill the CPT codes 97597-95798 or 11042-11047 on the same day the graft is applied which indicate debridement of the wound? And finally, what about billing for the E/M code 99212-99215?
The CPT code for the graft application is site/size dependent. Hence the large number of codes. As for the other codes you asked about:
The actual graft application includes a minor amount of prep work and assumes the recipient site is ready for a graft. Hence no reimbursement for 150X prep codes on the same date as graft application.
As for E/M, as you know, every surgical procedure has an inherent E/M and thus no separate e/m is allowed unless under the umbrella room of separate and distinct.
I am not hearingthat hence no separate e/m is allowed on the same date of services as the graft application.
As for the product code there are hundreds and one is expected to match as close as possible the size of the graft to the wound with as little waste as possible.
Please bear in mind that you can over ride the billing systems with the 25 modifer and other modifiers, but you will be caught on audit.
There is a whole sequence of coding issues which need to be addressed regarding the product, but as that is not part of the original question, I will hold that for another time.