General Surgery Coding Alert

Question: How should I report wound preparation with debridement of eschar when the surgeon also applies Oasis? Should I use 15175 or 15430 along with the debridement codes?

Arkansas Subscriber

Answer: For application of Oasis Wound Matrix, you should report 15430 (Acellular xenograft implant; first 100 sq cm or less, or 1 percent of body area of infants and children). You can also code for the Oasis supply using HCPCS code J7341 (Dermal [substitute] tissue of non-human origin, with or without other bioengineered or processed elements, with metabolically active elements, per square centimeter).

Because Oasis is a matrix derived from porcine submucosal tissue, it is an acellular xenograft (meaning it comes from a different species). In contrast, you would use 15175 (Acellular dermal replacement, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children) to describe acellular dermal replacements -- such as Integra -- that include synthetic materials like silicone in their composition.

At the same time, you need to be sure you follow CPT guidelines and report 15430 only when the surgeon surgically fixes Oasis to the wound and does not just apply or stabilize it with dressings. Also make sure that the type of fixation (suture, Steri-Strip, etc.) is documented in the patient's chart.

Other limitations: CPT instructions also prevent you from reporting 15430 with skin debridement codes 11040-11042 (Debridement; skin -) or surgical site preparation codes 15002-15005 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar or scar [including subcutaneous tissues], or incisional release of scar contracture -). According to CPT 2006 Changes: An Insider's View, the AMA considers site preparation and debridement to be minimal for this procedure and therefore includes these services in the graft code.

In addition, the national Correct Coding Initiative (CCI) bundles simple, intermediate, and complex repair codes (12001-13153), as well as casting, splinting, and strapping codes (29000-29550), into most skin replacement surgery and skin substitute procedures (15050-15431).

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program.