Dermatology Coding Alert

Question: A patient came to our dermatology practice with ulcers of plantar and hallux surfaces on both of her feet. The dermatologist debrided all areas and performed a dermagraft. How should I code this?


New York Subscriber

Answer: For the initial dermagraft application, as long as the dermatologist performed extensive site preparation, such as ulcer excision, you should report code 15000 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar [including subcutaneous tissues]; first 100 sq cm or 1 percent of body area of infants and children). 

On the other hand, if your dermatologist performed a simple ulcer debridement for this initial dermagraft application, you should report either 11040 (Debridement; skin, partial thickness) or 11041 (...skin, full thickness) depending on the dermatologist's documentation details of the depth of the debridement.

If your dermatologist debrides more than one ulcer, you can bill the appropriate code from the 11040-11044 range, depending on the skin thickness of the debrided ulcer. But remember to append appropriate modifiers.

Tip: If the dermatologist debrided multiple ulcers on two feet, you should append either modifier -LT (Left) or  -RT (Right). If the dermatologist debrided multiple ulcers on the same foot, you should append modifier -59 (Distinct procedural service) for the additional ulcers.

If your dermatologist performs subsequent dermagraft applications, he may or may not debride the ulcer. Therefore, you should not report code 15000. 

Solution: If the dermatologist debrided the ulcer, you can report 11040 or 11041 depending on depth, as in the initial dermagraft procedure. 

Red flag: If the dermatologist simply cleans the wound and applies a new Dermagraft, you should not receive a separate payment for site preparation.

You should also report code 15342 for the dermagraft application (Application of bilaminate skin substitute/neodermis; 25 sq cm) and +15343 (... each additional 25 sq cm [list separately in addition to code for primary procedure]) for each additional 25 sq cm. 

Remember: No matter how many wounds the dermatologist treats, you use the total amount of dermagraft the dermatologist applied to determine the correct code.