Wiki Epifix Application and Debridements

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bsievering

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We recently started using and billing Epifix in our wound care facilities. We use 15271 and 15272 (add on) as the application codes, with Q4131 as the product code.

Our provider was wondering if debridement codes such as 97597, 11042, 11043, or 11044 could be billed with these codes or if they were already included in the Epifix codes.

(I am not the biller for this, but was asked by a co-worker to put this question out to see what kind of responses we got.)
 
Per CMS NCCI guidelines "Debridement of a skin wound (e.g., CPT codes 11000, 11042-11047, 97597, 97598) prior to a graft/skin substitute is included in the skin graft/skin substitute procedure (CPT codes 15050-15278) and should not be reported separately." NCCI does allow a modifier to unbundle the debridement from the skin substitute application as a separate procedure if a modifier (59, XE, XS, XP, XU) is supported (e.g. if the procedure is performed at a different anatomical site).
 
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this is old, but it still comes up on a google search, so just so the info is in here - have a look at the 15002 code range to see if what you're provider is calling "debridement" actually falls into the "preparation of the recipient site" codes. The notes prior to 15002 state that a "debridement" is only applicable when the wound is being left to heal by secondary intention. Skin substitute grafts are a form of primary closure.
 
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