Collagen Dressings

Question:

Our physicians would like to start using and billing collagen dressings for all post-surgical patients in the global period to aid with healing and have the dressings shipped directly to the patient and used at the patient’s home. What are the coding and billing requirements for reporting the service?

Answer:

Thank you for your inquiry.  Several factors have to be considered.

First, using collagen dressings for routine dressing changes (e.g., all patients, as noted in the inquiry) during the global period would not meet the LCD requirements for payment consideration.

Routine dressing changes during the global period are included in the global surgical package per Medicare and, therefore, would not be separately reimbursable.

Per Medicare Claims Processing Manual, Chapter 12, Section 40.1

o   Miscellaneous Services - Items such as dressing changes; local incisional care; removal of the operative pack; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes.

Second, suppose the clinic wants to utilize these collagen dressings for routine postoperative patients during the global. In that case, the clinic will need to either absorb the cost and provide it to the patient or obtain an ABN or waiver from the patient advising them it is a non-covered service and give them the option if this is an item they would like to pay for out of pocket.  Depending on medical necessity, the dressings may or may not be covered under a home health benefit.

Medicare has an LCD—Surgical Dressings (L33831), with specific medical necessity requirements for coverage and payment. As with all reported services, medical necessity and the required reporting criteria must be documented.

Per Medicare LCD L33831:

Collagen Dressing or Wound Filler (A6010, A6011, A6021 – A6024)

A collagen-based dressing or wound filler is covered for full-thickness wounds (e.g., stage 3 or 4 ulcers), wounds with light to moderate exudate or wounds that have stalled or not progressed toward a healing goal.  They can stay in place for up to 7 days.  Collagen-based dressings are not covered for wounds with heavy exudate, third-degree burns, or when active vasculitis is present.

To justify payment for DMEPOS items, suppliers must meet the following requirements:

• Standard Written Order Criteria (SWO)

• Medical Record Information (including continued need/use if applicable)

• Correct Coding

• Proof of Delivery

Medicare reimburses surgical dressings under the Surgical Dressings Benefit. This benefit only covers primary and secondary surgical dressings used on the skin of specified wound types.

Refer to the related Policy Article NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES for information about these statutory requirements.

LCD L33831 (Surgical Dressings) and Coverage Policy Article A54563 for complete details for reporting surgical dressings. 

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33831

As with all reported services, medical necessity and the required reporting criteria must be documented. If all Medicare LCD requirements are not met, an ABN would need to be obtained. Check your private payor policies for coverage. KZA does not recommend billing the patient for Collagen dressings for routine wounds if medical necessity is not met (e.g., all postoperative patients).

*This response is based on the best information available as of 10/17/24.

Component Seperation

Question:

Our provider has documented abdominal closure by component separation, is there a separate CPT code for this closure or is it included in the main procedure?

Answer:

Component separation, sometimes referred to as a rectus advancement flap, refers to a myocutaneous flap of the trunk (a flap of subcutaneous tissue, fascia and muscle with an intact vascular supply) represented by CPT code 15734. To report this code the providers documentation must demonstrate that the oblique, transversalis or transverse abdominus and rectus abdominus muscles have been incised and mobilized toward the midline with an intact vascular supply. This code can be reported only once for each side and bilateral modifier does not apply, so when performed bilaterally report as 15734, 15734-59.​

*This response is based on the best information available as of 10/3/24.

Documentation for Modifier 22

Question:

What documentation is needed to report modifier 22?

Answer:

To be able to append modifier 22 which represents an increased procedural service, the provider needs to demonstrate that the work required was substantially greater than normally expected. To support this, the documentation must provide more than a blanket statement and include details as to why the work was greater. For example: “extensive lysis of adhesions took greater than 90 mins prior to reaching (the intended site)”.  The “what made it more work” is less crucial than the “details that explain why” it was more difficult so that payors will allow increased reimbursement. 

*This response is based on the best information available as of 7/11/24.

Umbilical Hernia Repair with another Laparoscopic Procedure

Question:

When our surgeon is performing a non-hernia laparoscopic procedure and a port is placed in the umbilicus, can we also code to repair a known asymptomatic umbilical hernia at the same time as the non-hernia laparoscopic procedure?

Answer:

No;  when a laparoscopic port is placed at the umbilical site, the repair of the umbilical hernia would be considered included and not separately reported. 

*This response is based on the best information available as of 620/24.

Breast Biopsies on Both Breasts – Same Session

Question:

Our breast surgeon performed biopsies (with a clip) on both the right and left breasts using ultrasound imaging. Do we code 19083 x 2 units since they are different breasts, or would we use 19083 and 19084 as the add-on code?

Answer:

If additional lesions (as you have described above) are biopsied in the contralateral breast using the same imaging, report the primary code and the add-on code for the second lesion. If more than one lesion is biopsied, using different imaging modalities, report the appropriate primary code for each.

*This response is based on the best information available as of 4/11/24.

Selective Debridement of Multiple Ulcers

Question:

Selective debridement was performed on 3 separate ulcers, 3 ulcers of the distal legs; 2 are on the right leg and 1 is on the left leg. Depth and size of debridement is documented as 

1. 15 sq cm, skin, subcutaneous tissue and muscle, right leg 

2. 10 sq cm, skin, subcutaneous tissue and muscle, left leg 

3. 10 sq cm, skin, subcutaneous tissue, muscle, and bone 

How is this reported? 

Answer:

Selective debridement of ulcer of the same depth are added together, regardless of their location. So, in the above scenario, the debridement of subcutaneous tissue and muscle are summed, for a total of 25 square centimeters. This is reported as codes, 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or and +11046 each additional 20 square cm or part thereof.  

The additional 10 square centimeter to a depth to bone are reported with code 11044, Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less.  

*This response is based on the best information available as of 3/14/24.