Coding Corner December 2011

Collagenase Injection
Two new codes were approved to report injection of collagenase for Dupuytren's contracture and follow-up manipulation.  These codes will become effective January 1, 2012 – do NOT report these codes before that date or your claim may be rejected.

 

20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren's contracture)

 

26341 Manipulation, palmar fascial cord (ie, Dupuytren’s cord), post enzyme injection (eg, collagenase), single cord

 

 (Report custom orthotic fabrication/application separately)

 

CPT code 20527 has been assigned 0-day global period and is valued slightly greater than a carpal tunnel injection (work RVU = 1.00) 

 

CPT code 26341 has been assigned a 10-day global period and includes the manipulation work on the day after the injection and one follow-up visit within 10 days. Based on the RUC survey responses, the ASSH recommended and the RUC agreed that the work RVU for 26341 was between two level 3 office visits [2x99213] and one level 3 visit plus one level 2 visit [1x99213 plus 1x99212].  However, in the Physician Fee Schedule Final Rule for CY2012, CMS disagreed and proposed a much lower work RVU of 0.91.  This is less than one level 3 office visit which has a work RVU or 0.97.

 

In the Rule, CMS states "After clinical review of CPT code 26341, we believe that a work RVU of 0.91 accurately reflects the work associated with this service. We believe the service described by CPT code 26341 is analogous to CPT code 97140 (Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes) which has a work RVU of 0.43. However, CPT code 97140 has no post-service visits, while CPT code 26341 includes 1x99212 office visit. To account for this difference, we added the work RVU of 0.48 for CPT code 99212, to the work RVU of 0.43 for CPT code 97140, for a total work RVU of 0.91. Therefore, we are assigning an interim final work RVU of 0.91 to CPT code 26341 for CY 2012."

 

Needless to say, CMS' logic has no clinical basis and is just one of many arbitrary decisions made for CY2012 to reduce payment for procedure codes.  The ASSH and the RUC will be commenting to CMS against this "interim" value, but the fact is that any change, if approved, would not become effective until CY2013.

 
Skin Substitute Grafts
The New Year will bring significant changes to reporting the application of skin substitute grafts. Twenty-four codes that were product specific (eg, allograft) will be deleted and replaced by eight codes that are distinguished according to anatomic location and surface area rather than by product description. Codes for split-thickness and full-thickness grafts remain unchanged.  The supply of skin substitute graft(s) should be reported separately in conjunction with 15271-15278. Also remember that for coding purposes, the wrist is considered part of the arm.

 

15271 Application of 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

 

+15272 each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

 

 (Use 15272 in conjunction with 15271)

 

 (For total wound surface area greater than or equal to 100 sq cm, see 15273, 15274)

 

 (Do not report 15271, 15272 in conjunction with 15273, 15274)

 

15273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

 

+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 (List separately in addition to code for primary procedure)

 

 (Use 15274 in conjunction with 15273)

 

 (For total wound surface area up to 100 sq cm, see 15271, 15272)

 

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

 

+15276 each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

 

 (Use 15276 in conjunction with 15275)

 

 (For total wound surface area greater than or equal to 100 sq cm, see 15277, 15278)

 

 (Do not report 15275, 15276 in conjunction with 15277, 15278)

 

15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

 

+15278 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 (List separately in addition to code for primary procedure)

 

 (Use 15278 in conjunction with 15277)

 

 (For total wound surface area up to 100 sq cm, see 15275, 15276)

 

 (Do not report 15271-15278 in conjunction with 97602)

 

Before reporting, sum the surface area of all wounds requiring grafts from the same anatomic site and report the appropriate primary code and add-on code in multiples, as appropriate.  The following table summarizes the coding matrix.

 

 

 

Coding Example:
A mechanic was admitted to hospital with burns on both arms and hands, after his gasoline-saturated clothing was ignited from a spark.  Surgical excision of the burn tissue from his right hand beginning at the wrist was performed (reported separately).  He now undergoes application of 250 sq cm of skin substitute graft on his arms and 180 sq cm of skin substitute graft on his hands and fingers.

 
Procedures to Report:

 

Arms:

 

15273  Skin substitute graft, trunk, arms, legs, first 100 sq cm

+15274  Skin substitute graft, trunk, arms, legs, additional 100 sq cm, or part thereof

+15274-59  Skin substitute graft, trunk, arms, legs, additional 100 sq cm, or part thereof

 

Hands, Fingers:

 

15277  Skin substitute graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, first 100 sq cm

+15278  Skin substitute graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, additional 100 sq cm, or part thereof

 

Additional Notes: 
CPT coding instructions do not indicate that modifier 59 be appended to add-on codes.  However, some payers may require appending modifier 59 to the second and subsequent add-on codes to indicate that these add-on codes are not simply inappropriate duplicate billing.  In addition, modifier 51 is not appended to any of these codes.  Many payers (including Medicare) recommend against reporting modifier 51 on claims.  Their processing system has hard-coded logic to append the modifier to the correct procedure codes submitted on the same claim.  You should follow the rules of your payers.