Coding for Wound Care in 2011: Updates and Changes .


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New ICD-9 codes were presented for 2009 Are YOU utilizing them?. For ICD-9 codes 707.00-707.09 the word
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Coding for Wound Care in 2011: Updates and Changes

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New ICD-9 codes were presented for 2009 Are YOU utilizing them? For ICD-9 codes 707.00-707.09 "Decubitus" has been supplanted with "Weight" New Codes: 707.20 – Pressure ulcer, unspecified stage 707.21 – Pressure ulcer, organize 1 707.22 – Pressure ulcer, arrange 2 707.23 – Pressure ulcer, arrange 3 707.24 – Pressure ulcer, arrange 4 729.90 – Disorders of delicate tissue, unspecified

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Ulcer & Wound Grading Wagner – 6 Grades UTSA – Lesion Depth with both Ischemia & Infection (Stage A-D, Grade 0-III) Pressure – 4 +2 Doesn\'t make any difference which framework you use the length of you depict the ulcer sufficiently

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Pressure Ulcer Grading System Adopted in Feb. 2007 by the National Pressure Ulcer Advisory Panel: Suspected Deep Tissue Injury - Purple or maroon range of stained in place skin or blood-filled rankle.

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Pressure Ulcer Grading System Stage 1 – Intact skin with non-blanchable redness or a restricted region as a rule over a hard conspicuousness.

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Pressure Ulcer Grading System Stage 2 – Partial thickness loss of dermis exhibiting as a shallow open ulcer with a red pink injury bed.

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Pressure Ulcer Grading System Stage 3 – Full Thickness tissue misfortune. Subcutaneous fat might be obvious, however bone, ligament or muscle must not be uncovered.

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Pressure Ulcer Grading System Stage 4 – Full Thickness tissue misfortune with uncovered bone, ligament, or muscle. Bog and eschar might be available on a few sections of the injury bed.

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Pressure Ulcer Grading System Unstageable – Full thickness tissue misfortune in which the base of the ulcer is secured by quagmire or potentially eschar in the injury bed.

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Ulcer ICD-9 Codes Lower appendage 707.10 Ankle 707.13 Calf 707.12 Heel, Midfoot 707.14 Foot, Toes 707.15 Specified site NEC 707.19

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Codes For Skin Replacement Surgery The skin substitute application codes are being reconsidered by CPT and "ought to be" accessible in CPT 2012 Indications are that there will be codes in view of size of skin substitute alone and not tissue sort particular Wound site arrangement will be permitted to be utilized with application codes Hope to have 0-or 10-day globals

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Codes For Skin Replacement Surgery There are codes for "Surgical Preparation," in the past called Wound Bed Preparation. The codes are: 15002 15003 15004 15005

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Codes For Skin Replacement Surgery CPT 15002 – Surgical Preparation or making of beneficiary site by extraction of open injuries, smolder eschar, or scar (counting subcutaneous tissues), or incisional arrival of scar contracture, trunk, arms, legs; initial 100 cm 2 or 1% of body zone of newborn children and youngsters. CPT 15003 – Each extra 100 cm 2 or each extra 1% of body range of newborn children and kids.

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Codes For Skin Replacement Surgery CPT 15004 - Surgical Preparation or production of beneficiary site by extraction of open injuries, blaze eschar, or scar (counting subcutaneous tissues), or incisional arrival of scar contracture, confront, scalp, eyelids, neck ears, circles, genitalia, hands, feet as well as different digits; initial 100 cm 2 or 1% of body range of babies and youngsters. CPT 15005 - Each extra 100 cm 2 or each extra 1% of body territory of newborn children and kids.

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Codes For Skin Replacement Surgery CPT 15002, 15003, 15004 & 15005 CAN be utilized with: 15050 – 15251 15330 – 15336 15360- - 15366 15400 – 15421 They CANNOT be utilized with: 15340 – 15341 15430 – 15431

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Codes For Skin Replacement Surgery CPT 15150-15157 (per 25 cm 2 ) APC – 0135 90-day worldwide Tissue refined epidermal autograft Cultured autologous skin with just an epidermal layer HCPCS – Q4100 (NOS) e.g., CEA , Epicel , EpiDex Check Medicare LCDs and other protection arrangements for bay wrath of copies

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Codes For Skin Replacement Surgery CPT 15170-15176 (per 100 cm 2 ) APC – 0134 90-day worldwide Acellular dermal substitution A tissue-inferred or made gadget that gives quick, temp. wound conclusion & that joins into the injury and advances the era of a neodermis that can bolster epidermal tissue Integra Wound (510 K Clearance for wound care) - Q4108 Check Medicare LCDs and other protection arrangements for inlet seethe

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Codes For Skin Replacement Surgery CPT 15300-15321 (per 100 cm 2 ) APC – 0135 90-day worldwide Allograft skin Cadaveric human skin allograft HCPCS - Q4111 Homograft-skin from skin banks; Gamma Graft (510-K leeway for wound care) Check Medicare LCDs and other protection approaches for bay anger

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Codes For Skin Replacement Surgery CPT 15330-15336 (per 100 cm 2 ) APC – 0135 90-day worldwide Acellular dermal allograft Decellularized allogeneic dermis may require quick simultaneous scope with autologous tissue e.g., Alloderm , Graft Jacket (510-K freedom for wound care) HCPCS code Q4107 ( Q4113 for Xpress) Check Medicare LCDs and other protection policies for scope

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Wound Care Code Modifiers Check Medicare LCD for particular use for: KX modifier (Skin substitute items and their application strategies for which the skin substitute was taken care of, connected, and immobilized suitably and as indicated by makers\' mark directions) JC (Report skin substitute items utilized as a skin unite JD (Report skin substitute items not utilized as a skin join) JW (Product squandered - disposed of)

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Codes For Skin Replacement Surgery CPT 15340-15341 (per 25 cm 2 ) G0440/G0441 (Medicare codes) APC – 0134 10-day worldwide Tissue refined allogeneic skin substitute with both a dermal and epidermal layer e.g., Apligraf ( Q4101 )

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CPT 15340 & 15341 CPT 15340 & 15341 have a 10-day worldwide period G0440/G0441 have 0-day worldwide Post-unite application visits are repaid after day 10 The HCPCS Q4101 supply code for the item can be charged independently x 44 units 15002-15005 & debridement code (11042) incorporated into installment of all codes

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Codes For Skin Replacement Surgery CPT 15360-15366 (per 100 cm 2 ) G0440/G0441 (Medicare codes) APC – 0134 90-day worldwide Tissue refined allogeneic dermal substitute Cultured allogeneic neonatal fibroblasts e.g., Dermagraft ( Q4106 )

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Codes For Skin Replacement Surgery CPT 15365 & 15366 have a 90-day worldwide period (utilize - 58 to sidestep worldwide) G0440/G0441 have 0-day worldwide CPT 15002 (leg) & 15004 (foot/lower leg) can be utilized for "surgical planning of beneficiary site" with 15365/15366, not with "G" codes HCPCS code Q4106 for the item can be charged independently x 37.5 units

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Codes For Skin Replacement Surgery CPT 15400-15421 (per 100 cm 2 ) APC – 0135 90 day worldwide Xenogeneic dermis - nonhuman dermis for transitory injury conclusion e.g., EZ Derm , Mediskin (510-K endorsement for wound care) Q4100 (not generally determined code) Check Medicare LCDs and other protection arrangements for bay wrath

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Codes For Skin Replacement Surgery CPT 15430-15431 for each 100 cm 2 APC – 0135 90 day worldwide Acellular xenogeneic embed – de-cellularized nonhuman connective tissue Oasis, Surgisis , PriMatrix , MatriStem (510 K endorsement for wound care) Check Medicare LCDs and other protection approaches for bay fierceness

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CPT 15430 &15431 CPT 15430 & 15431 have a 90-day worldwide period Post-join application visits are incorporated into the repayment (9 level II visits) DO NOT USE MODIFIER – 58 HCPCS code for Oasis is Q4102 HCPCS code for PriMatrix is Q4110 HCPCS code for Surgisis & MatriStem is Q4100 (not generally determined code) CPT 1500x & Debridement codes (11042 ) included

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Codes For Skin Replacement Surgery "These codes are not expected to be accounted for straightforward join application alone or application balanced out with dressings ( e.g., by basic bandage wrap ). " "The Skin substitute/unite is tied down utilizing the specialist\'s decision of obsession . At the point when administrations are performed in the workplace, the supply of the skin substitute/join ought to be accounted for independently. Routine dressing supplies are not announced independently."

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Reimbursement for Advanced Wound Care Modalities How payers decide scope Product grouping Clinical confirmation FDA endorsement ( PMA versus 510 K) Existing arrangements CAC conclusion Literature Public remark

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Common Products utilized for Advanced Wound Care

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CMS & Advanced Wound Care Modalities Some MACs are in a "condition of flux" The quantity of Medicare temporary workers is being consolidated LCDs are being changed and re-blended Evidence-based items are being repaid CACs part is changing Not a decent time to be a recently recorded methodology Private protection may consider numerous as trial & investigational

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Change in Wording + New Code 11042 Debridement , subcutaneous tissue (incorporates epidermis and dermis, if performed); initial 20 cm 2 or less Add-on: 11045 each extra 20 cm 2 , or part thereof

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Change in Wording + New Code 11043 Debridement, muscle, or potentially belt (incorporates epidermis, dermis, and subcutaneous tissue, if performed); initial 20 cm 2 or less Add-on: 11046 each extra 20 cm 2 , or part thereof

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Change in Wording + New Code 11044 Debridement, bone (incorporates epidermis, dermis, subcutaneous tissue, muscle and additionally sash, if performed); initial 20 cm 2 or less Add-on: 11047 each extra 20 cm 2 , or part thereof

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CMS & Debridement Many CMS medicinal executives have communicated in their LCDs that the

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