Otolaryngology Coding Alert

Question: How should I bill for Cymetra?

Maryland Subscriber

Answer: Cymetra is a mixed tissue product derived AlloDerm. Otolaryngologists may use Cymetra, which is made from donated human dermal tissue, to replace damaged or inadequate tissues. The product has the added benefit of containing the tissue structure's vital elements, such as collagens, elastin and proteoglycans, in a packaged form with a shelf life up to two years. An otolaryngologist delivers the particulate form of AlloDerm, Cymetra, by injection. For the tissue, you may bill a supply code.

Two possible reporting options exist based on the insurer assuming the doctor provides the supply in the office. Hospitals include supply costs in their fees, in which case the facility, not the physician, reports the supply codes. But, if the physician uses Cymetra tissue in the office for a patient whose insurance, such as Blue Cross/Blue Shield, Medicare and Health Insurance Association of America, accepts HCPCS level-two supply codes, you should report Q0183 (Dermal tissue, of human origin, with and without other bioengineered or processed elements, but without metabolically active elements, per square centimeter), says LifeCell Corp., the tissue's manufacturer.

HCPCS designates Q0183 as a code that is left to "carrier discretion," so you should contact the insurer for specific coverage information.

To report the product to other payers, for instance Medicaid and Aetna US Healthcare, which do not accept HCPCS level-two supply codes, assign 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]). Enclose a copy of the invoice with the claim to identify the specific supply used. Otherwise, the insurer may deny coverage for the general supply code.

Remember that these are manufacturer recommendations, and actual reimbursement guidelines may vary. Further, Cymetra is a costly product, which the insurer may not pay for at all. Therefore, you must preauthorize with the payer before the physician uses the product.

Answers to You Be the Coder and Reader Questions provided by Shawn Langston, CPC, coder for Mitchell D. Kaye, MD, FACS, in Hopkinsville, Ky.