General Surgery Coding Alert

Halt 15340, 15360 'global days' prejudice.

When your surgeon applies a tissue-cultured skin or dermal substitute for Medicare patients with lower extremity ulcers due to venous statis or diabetes, you have two temporary "G" codes you should be using this year.

Shift From CPT® to HCPCS for Medicare

Whether Apligraf or Dermagraft, you should use G0440 (Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less) and G0441 (... each additional 25 sq cm) to report your surgeon's work in 2011.

That's a change from using existing CPT® codes for the service, which depend on the type of skin or dermal substitute as follows:

• Apligraf -- 15340-+15341 (Tissue cultured allogeneic skin substitute ...)
• Dermagraft -- 15360-+15361 (Tissue cultured allogeneic dermal substitute, trunk, arms, legs ...) or 15365-+15366 (Tissue cultured allogeneic dermal substitute, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits ...)

You should continue to use the 15300-series codes for most non-Medicare payers.

Lose the Brand Incentive

Although your surgeon may prefer one skin or dermal substitute product or the other for clinical reasons in specific cases, coverage quirks for the CPT® codes can provide payment loopholes that sway product choice.

Problem: "General surgeons, podiatrists, plastic surgeons, and wound care specialists were concerned that Apligraf had a 90-day global period versus Dermagraft, which had a 30-day global period," stated Marc Hartstein, deputy director for the Center for Medicare Hospital and Ambulatory Policy Group in his presentation with Kenneth Simon, senior medical officer for Center for Medicare, presented during the CPT® and RBRVS 2011 Annual Symposium. This caused providers to use one product over another to gain financial advantage.

Also, 15340-+15341 include site preparation and debridement, while you can bill those services separately with 15360-+15366.

Solution: Used for either Apligraf or Dermagraft, codes G0440-G0441 have 0 global days and include the site preparation and debridement services. "The new codes, together with a 0-day global billing period, will eliminate unequal financial incentives in the selection of products forthe treatment of chronic wounds as well as help ensure that physicians make their treatment decisions based solely on clinical benefit," states Geoff MacKay, CEO of Organogenesis in a press release.

Look ahead: CMS will work on valuing G0440 and G0441 during 2011 to pave the way for CPT® 2012 to offer category III codes to replace the temporary G codes.