Are You Using CPT 15004 For Cellular/Tissue-Based Products For Wounds?
There are multiple coding considerations when it comes to the application of cellular and/or tissue based products, formerly known as “skin substitutes,” for wounds. One of these considerations deals with the preparation of the ulcer the clinician will be treating. Physicians often ask me if it is appropriate to use CPT 15004 prior to application of a cellular/tissue based product.
First, we must look at the CPT description: “Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children.” Using this code is certainly appropriate if the work you performed is consistent with what is described here if your Local Coverage Determination (LCD) does not comment otherwise.
If your Medicare Administrative Contractor (MAC) has an LCD for cellular/tissue based products, be sure to check it for any mention of CPT 15004. There have been cellular/tissue-based product LCDs that have listed CPT 15004 under the “non-covered procedures” section. Others list it as a code that one can use as part of the preparation to receive a cellular/tissue based product. Always check your LCD for guidance on the use of this code. Many non-Medicare payers issue coverage determinations for cellular/tissue-based products as well.
Do not use CPT 15004 and CPT 15275 during the same encounter. There is no written policy that limits the number of days prior to application of the cellular/tissue-based product that you can “prepare” the recipient site. As with anything in coding, always consider what is medically necessary when it comes to this timing.
Do not use CPT 15004 if you do not plan on grafting.
CPT 15004 can be an attractive and useful code when preparing a site to receive a cellular/tissue-based product. Before using this code, be sure the work performed matches its description and that you have checked the carrier’s CPT policy.
Dr. Lehrman is on the APMA Coding Committee, serves as an expert panelist on Codingline, and is a Fellow of the American Academy of Podiatric Practice Management (AAPPM). Follow him on Twitter @DrLehrman
Dr. Lehrman will be lecturing on “Coding For Ulcer Debridement” at the new Advance by Podiatry Today conference Oct. 13-15 in Chicago. To register for the conference, visit www.podiatrytoday.com/advance .
