Part B Insider (Multispecialty) Coding Alert

Talk to your payers to see if Q codes need a modifier to prevent denials.

Because Medicare didn’t release directives with the release of skin substitute modifiers JC and JD, Medicare contractors can come up with their own directions for the modifiers’ use. The challenge to you is connecting with your payers to learn their policies and to get a firm grip on the difference between the two modifiers. 

Keep reading to introduce yourself to JC and JD and how to use them so you can decrease your chances of being denied.

Combine JC with Graft and JD with Dressing

You will use the JC (Skin substitute used as a graft) and JD (Skin substitute not used as a graft) modifiers when you’re coding for bioengineered skin substitutes. The difference between the two modifiers is whether the skin substitute is used as a graft or as a skin covering. 

The definition of a skin graft for this purpose is whether the skin substitute is implanted into the wound to be incorporated in the healing of the wound. If the skin substitute is used to cover a wound or to protect it from contamination or fluid loss, then it is not a graft, but a dressing and you would use modifier JD.

When a patient in your practice receives a skin substitute graft, you would code from the 15271-15278 (Application of skin substitute graft to …) range or from HCPCS skin repair code range (Q4100-Q4121) with the appropriate J modifier and a site modifier — either RT (Right side) or LT (Left side).

Example of when to use JC: A patient presents with diabetic foot ulcers that aren’t healing. Your physician decides to treat the ulcers surgically with debridement and application of a skin substitute in order to promote healing. You would report code Q4101 (Apligraf, per square centimeter) for the skin substitute material with modifier JC attached to alert payers that the material was used as a graft and either RT or LT.

Example of when to use JD: Another patient presents with a diabetic foot ulcer on her left foot that is healing slowly. Your physician decides to use some skin graft material as part of the dressing to protect the wound from fluid loss and contamination to promote healing. You would report the code for the material such as Apligraf (Q4101), with modifier JD attached indicating that the material was used as a dressing and LT to indicate the left foot.

Talk to Your Payers to Get Their Directives

Since each Medicare contractor may issue its own directions for the use of JC and JD, be sure you learn your payer’s rules.

“Each Medicare contractor gets to decide whether they will require use of JC and JD modifiers and, if they do require the modifiers, what the specific rules are for use of the modifiers,” says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CCC, COBC, CPC-I, internal audit manager at PeaceHealth in Vancouver, Wash. “My informal survey indicates that many carriers do require use of JC and JD modifiers and that their use is dictated by the way the material is used. However, each hospital should contact their carrier for directions about whether and how these modifiers should be used and what restrictions there may be on payment related to the use of the products and modifiers.”