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Marianne Posted Wed 14th of August, 2013 13:49:00 PM

This question is for facility/ASC coding.

Here is the OP Note: The left foot was addressed and the ulceration was debrided of all hyperkeratotic tissue and the granulated wound was then freshened up to bleeding tissue. This was irrigated with pulsed lavage system. An Apligraf 100% was applied to the wound of the left ankle and foot. WE noted to have good correction at this time. Betadine-soaked Adaptic, 4x4s, cling,kerlix and an ace bandage with coban dressing was applied to the foot.....

He did NOT suture/anchor the graft in place. I think to use an "application of skin substitute graft" code 15271-15278 the graft must be anchored.

If he did not anchor the graft I don't think I can use 15004 either because in the CPT book "do not report 15002-15005 for removal of nonviable tissue/debris in chronic wound (eg;, diabetic) when the wound is left to heal by secondary intention." When the surgeon is not closing the wound, is that secondary intention?

Can I use just a debridement code 11042 with the Apligraf Q4101, and yet actually I don't know from this note if he debrided subq tissue or epidermis/dermis only.

I know I have to code a procedure with a Q4101, but I don't know if I can code debridement only or if this should have been performed in the office with an E/M code. HELP PLEASE!!! Thanks.

Marianne Posted Mon 19th of August, 2013 14:05:20 PM

Are you still working on this one?

SuperCoder Answered Mon 19th of August, 2013 15:41:21 PM

I think they can use 15275 (or possibly 15277) depending on the size of the graft. The skin substitute graft is applied and even if it is held in place with the dressing I think that is OK - I don't think it has to be sutured. I think they can also use 11402 for debridement in this situation

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