Podiatry Coding & Billing Alert

Question: Our podiatrist documented an 8.5 cm excision (56.75 sq. cm), and but a 40 sq. cm OASIS® Matrix for treating a foot ulcer of Medicare diabetic patient. How should I code this procedure?

Alabama Subscriber

Answer: For the skin substitute graft, you should report as 15275 (Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area) plus two units of +15276 (... each additional 25 sq cm wound surface area, or part thereof [List separately in addition to code for primary procedure]).

Under this procedure, the podiatrist prepares the wound surface in the region of the patient’s feet and/or multiple digits by first cleaning it with antiseptic. The physician then prepares the skin substitute graft according the shape and size of the wound. He then transplants the skin substitute graft to the wound, which is sterile now. The physician ensures that the skin substitute graft properly adheres to the area of the wound. This procedure prevents the wound from getting infected, covers the wound, and enables the skin to heal.

You should also report the HCPCS supply code for the graft used. Please check the exact OASIS® Matrix product used for the graft. The Centers for Medicare & Medicaid Services (CMS) has assigned brand-specific Level II HCPCS code, Q4124, to OASIS® Ultra Tri-Layer Matrix and Q4102 for OASIS® Wound Matrix. CMS has indicated that these brand-specific HCPCS codes are applicable for all sites of service that use the OASIS® Matrix products.

NOTE: The wound surface area mentioned in the procedure note applies to the size of the recipient site, not to the size or amount of product used.

When required and/or appropriate, report the name of the product, its size, its product number, and the invoice price per piece in the appropriate field of a paper claim or in the narrative field of an electronic claim.

The descriptions for HCPCS codes Q4102 and Q4124 refer to “per square centimeter.”

Examples:

• 3 cm x 3.5 cm = 10.5 sq cm

• 3 cm x 7 cm = 21 sq cm

• 5 cm x 7 cm = 35 sq cm

Physicians should document and report the number of square centimeters used and discarded for each application. The Medicare program provides payment for the amount of the drug or biological discarded as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label.