Wiki biller

[TCARBINO]

my name is tammy and i have a question. i am billing workmens comp for skin substitute dermagraft with Q4106 i have never billed workmens comp before so i didn't know i couldn't bill q codes to workmens comp. so they are denying code and told me i need to find another code in the ny state fee schedule
but i am having trouble can any one help me please.
thanks
tammy

 

[werner03]

Are you billing for the application or the graft? Q codes are temporary codes.

 

[KKMeeks]

Usually the workman's comp claim should have the codes you can bill on it, since the coverage would be strictly for what the claim is for.

 

[nanselmo]

Dermagraft Application

Dermagraft is best described with Q4106, Use MOD JC (skin substitute used as graft) if required by insurer. In addition you should include the name of the graft and size of graft on the narrative field of the CMS 1500 form. For the application of Demagraft use CPT 15365. When submitting your documentation to the wormens company, make sure your medical record includes the name of the graft and size. If you need further assistance please contact the Dermagraft Reimbursement Hotline at 866/866-7731.

 

[TammyHF]

Some insurers will accept Dermagraft old J-code J7342. Unless the patient is a diabetic the workman's comp will not cover the Dermagraft because under the description the graft is only covered for diabetic foot ulceration. Was the procedure precertified? I have found in the past it is best to get a prior authorization for any office visit, procedure, or brace when dealing with workman's comp.