“I have a patient with a nonhealing pressure wound on his right ankle and his right heel. I applied a skin graft substitute to both sites. I used a single piece and shared it between the two sites. The ICD 10 code I used for the ankle is L89.513. The ICD 10 code I used for the heel is L89.613. For the application codes I utilized CPT 15271-RT to the L89.513 and CPT 15275-RT to the L89.613. The CCI does not show any conflict, but I am wondering whether a -51 is necessary. I also used the correct Q code for the product.”
So, a patient has two pressure ulcers. One is located on the right ankle. The other one is located on the right heel. A skin graft substitute, or CTP (ie. Cellular and Tissue Based Product) was applied to both sites. A single piece of CTP was shared and applied to the two ulcers.
What about the application codes? Since the application codes are anatomically specific, two application codes are needed. The application code for the ulcer on the right ankle is CPT 15271 which is defined as the following:
Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface area.
The application code for the ulcer on the right heel is CPT 15275 which is defined as the following:
Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and or/multiple digits, total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface area.
As far as the coding and billing for the application of the skin substitute to the two ulcers is concerned, the coding scenario is the following:
CPT 15271 (L89.513)
CPT 15275 – 59 (L89.613)
It is important to note the following:
1. Anatomical modifiers are not utilized with this CPT code set. It is based upon the total wound surface area for the CPT code that is used. For example, if the CTP was applied to both heels, the linked ICD-10-CM codes L89.613 and L89.623 would define the anatomical sites.
2. The 51 modifier is not utilized. If the skin substitute or CTP is applied to two different wound/ulcer anatomical locations (ie. Right heel, right ankle), the 59 modifier is appended to the CPT code in question, in this case CTP 15275. The 59 modifier is used to demonstrate a distinct procedural service.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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