Q&A: Documentation and CPT coding for the application of a CTP
Q: What clinical information is needed to effectively code and bill for the application of a cellular tissue-based product (CTP)?
A: CTPs, commonly referred to as “skin substitutes,” are frequently used by providers to stimulate chronic wound healing and protect these injuries from infection.
When applying a CTP for treatment of an ulcer, providers should document the following information:
- Wound characteristics
- Size of the ulcer
- Location of the ulcer
- Severity of the ulcer
- Details about the encounter
- Date and time of application
- How the CTP was secured to the wound bed (e.g., Steri-Strip™, suture)
- Details regarding the type and amount of CTP used
- Amount of CTP used
- Amount wasted and reason for wastage
- Manufacturer’s lot number or the national drug code
Coders should select the appropriate CPT code for the application of a skin substitute based on the size of the wound on which the CTP was applied. CPT codes for skin substitute application describe the wound’s size and location on the body. For example, the following codes are used to report skin substitutes applied to the trunk, arms, or legs:
- 15271, application of a skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface area
- Add-on code 15274, …; each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof
Coders should also report the appropriate HCPCS Q codes to tell the payer what type of CTP was applied. For example, Q4132 is the supply code for Grafix® Q4101 is the supply code for Apligraf®. When reporting HCPCS codes for a skin substitute, coders should keep in mind that Medicare requires the use of modifier -JW (drug amount discarded/not administered to any patient) to show how much of the CTP was wasted, when applicable.
Consider the following scenario: A patient receives Apligraf (44 sq. cm) on a 10 sq. cm ulcer on the foot. Per the provider’s note, only 14 sq. cm was used, and 30 sq. cm was wasted. The bill would look like this:
- Q4101 x 14, Apligraf, per sq. cm
- Q4101-JW x 30
- 15275, application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface area
Editor’s note: Gloria Miller, CPC, CPMA, CPPM, vice president of reimbursement services at Comprehensive Healthcare Solutions Inc. in Seattle, answered this question during the HCPro webinar, “Combat Outpatient Wound Care Coding and Documentation Challenges in 2019.”
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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