Four Tips to Optimize Billing for Post-burn Grafts and Flaps
Published on Sun Jul 01, 2001
Following treatment, full-thickness burns must be covered to restore the skin barrier, reduce the risk of infection and prevent fluid and electrolyte loss. Covering also reduces scarring -- which can restrict range of motion (scar tissue is inflexible and frequently contracts, and is also more easily damaged and burned).
Typically, the affected area is dbrided and covered, or in some cases closed, using a graft or flap. Coding these services can be challenging because:
The size, location and type (full or split thickness) of the graft or flap may not be documented adequately.
The wrong ICD-9 code may be linked to the appropriate graft or flap procedure.
A series of staged grafts or flaps may be performed within the global period.
The medical terminology may be confusing. Any of these may result in payment that does not reflect the surgeon's work. Failing to distinguish between an allograft and a xenograft, for instance, could lead to incorrect coding. Similarly, linking an incorrect diagnosis code to the creation of a graft or flap may end in a denial. Tip No. 1: Don't Forget to Bill Site Preparation Code(s) After escharotomy (16035-16036) and necessary subsequent dbridements (16010-16030), the affected area must be covered with either a graft or flap. Graft or flap creation may be performed immediately, or weeks, after the initial escharotomy but usually takes place during the escharotomy's 90-day global period.
Before grafts or flaps can be created, however, the affected area must be cleared of all remaining eschar, skin debris and subcutaneous tissue to create a healthy, vascular tissue bed upon which the graft or flap is formed. CPT includes two codes for this preparation:
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 one percent of body area of infants and children
+15001 -- ... each additional 100 sq cm or each additional one percent of body area of infants and children (list separately in addition to code for primary procedure). Because it is an add-on code, +15001 should never be used on its own. Similarly, 15000, although not an add-on code per se (it does not have a "+" to its left in the CPT book and its descriptor does not include terminology to indicate it is an add-on code), also should not be used on its own, says Marcella Bucknam, CPC, senior practice coder with the University of Omaha in Nebraska. "This code is used to report the preparation of a site for a graft. If you don't do a graft, there is no reason to perform this service -- which means 15000 shouldn't [...]
