Wiki 15271-plea for help!

AT2728

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We recently started a Wound clinic in an office setting at the hospital. I'm billing for the professional services. The following was documented in the medical record and my doc states to bill 15271. Does this qualify? He is doing a lot of return Epifix applications when patients are seen back weekly and I'm concerned about medical necessity. I've spent hours trying to research but still can't locate specifically what information I need to provide for him to ensure we are only billing 15271 as necessary. In this instance, you'll see no further debridement to wound was needed, he simply replaced the Epifix. Any assistance would be greatly appreciated. I'm also concerned on this particular patient since Medicare LCD does not list a non-healing abd wound ulcer as covered-this is a commercial patient but they usually follow Medicare.

"His inferior abdominal wound is 4.1 x 1.2 x 0.1 cm. stage 3. The superior wound is 1.7 x 1.7 x 0.1 cm. stage 3. Both are healthy and clean. Epifix was replaced to both wounds and held
in place with steri-strips. Patient is doing well."
 
I believe your physician is correct. 15271 is for the application of skin substitute graft in the location and of the size you describe. It does include the removal of any previously applied graft material and debridement if performed, so do not report 97602 with it.
 
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