Coding for ankle wounds
Good Morning
We are applying grafts to ankle ulcers and I have a question about the code selection. Is the ankle considered part of the foot or the leg? I think it's leg but the provider's office is coding for the foot. I am trying to decide between these 2 codes:
1. 15271-"application of skin substitute graft to trunk, arms, legs"
2. 15275-"application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet"
Thanks
Beth
Beth Aldridge, CPC
Coding Manager
Northern California Medical Associates, Inc
Phone: (707) 573-6145
Fax: (707) 573-6932
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We are applying grafts to ankle ulcers and I have a question about the code selection. Is the ankle considered part of the foot or the leg? I think it's leg but the provider's office is coding for the foot. I am trying to decide between these 2 codes:
1. 15271-"application of skin substitute graft to trunk, arms, legs"
2. 15275-"application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet"
Thanks
Beth
Beth Aldridge, CPC
Coding Manager
Northern California Medical Associates, Inc
Phone: (707) 573-6145
Fax: (707) 573-6932
** CONFIDENTIALITY NOTICE ***
This e-mail transmission may contain PHI (Protected Health Information). If so, this e-mail is HIGHLY CONFIDENTIAL. It is intended for the exclusive use of the addressee. It is to be used only to aid in providing specific healthcare services to this patient. Any other use is a violation of Federal Law (HIPAA) and will be reported as such. If you have received this e-mail in error, please notify the sender immediately by reply e-mail. Please destroy all electronic and hard copies of the communication, including attachments.
Comments
"Small" Leg/Ankle Wounds
CPT 15271 (application of skin substitute graft to, for example, leg or ankle). This code is
based on a wound size (after cleansing, prepping, and/or debriding) maximum of 100 sq
cm. Specifically, this code is to be used for application of a skin substitute graft to a
wound surface area size of 0 to 25 sq cm (first 25 sq cm within the maximum wound size
grouping up to 100 sq cm).
If the leg/ankle wound area is greater than 25 sq cm, but less than the maximum of group size
up to 100 sq cm, then bill CPT 15271 plus
CPT 15272 for each additional 25 sq cm of wound surface area. The total wound surface area
treated cannot exceed 100 sq cm so you have the ability to bill CPT 15272 3 times, for example,
if skin substitute graft material is applied to 75.1 up to 100 sq cms of leg/ankle wound(s). Since
CPT 15272 is an "add-on" code, you would NOT apply a "-51" modifier. It is already discounted.
"Large" Leg/Ankle Wounds
CPT 15273 (application of skin substitute graft to, for example, leg or ankle). This code is
based on a wound size (singular or aggregate size; after cleansing, prepping, and/or
debriding) minimally of 100 sq cm*. Specifically, this code is to be used for application of
a skin substitute graft to a wound surface area size of 100 up to 200 sq cms (the code
itself represents the first 100 sq cm of a "large" leg/ankle wound treated).
If the leg/ankle wound area is greater than 100 sq cm, then bill CPT 15273 plus
CPT 15274 for each additional 100 sq cm* of wound surface area. For example, if you have an
aggregate sum of leg/ankle wound area calculated to be 375 sq. cm present bilaterally, you
would bill CPT 15273 (first 100 sq cm), CPT 15274 (next 100 sq cm), CPT 15274 (next 100 sq
cm), and CPT 15274 (next 75 sq cm). Since CPT 15274 is an "add-on" code, you would NOT
apply a "-51" modifier. It is already discounted.
* or 1% of body area of infants and children
Small" Foot/Toe Wounds
CPT 15275 (application of skin substitute graft to, for example, foot or toe(s)). This code is
based on a wound size (after cleansing, prepping, and/or debriding) maximum of 100 sq
cm. Specifically, this code is to be used for application of a skin substitute graft to a
wound surface area size of 0 to 25 sq cm (first 25 sq cm within the maximum wound size
grouping up to 100 sq cm).
Mindy L Dowd CPC,CPMA
Denver Arthritis Clinic
200 Spruce St
Suite 100
Denver,CO 80230
(303)302-7433
mdowd@dacdenver.com
Maxine
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Maxine Lewis, CMM, CPC, CPC-I, CCS-P, CPMA
Main: 513-771-7070
Direct: 513-672-4363
Fax: 513-326-7640
200 Northland Blvd
Cincinnati, OH 45246
mlewis@scrogginsgrear.com
www.scrogginsgrear.com