Skin Substitute

Overuse of skin substitutes (CTPs) to help heal wounds/ulcers has especially come under fire in recent years. Medicare spent more than $10 BILLION on these products in 2024 – more than DOUBLE what was spent the year prior.

“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 code 15271-RT for L89.513 and CPT code 15275-RT for L89.613. The NCCI Edits does not show any conflict, but I am wondering whether a -51 is necessary. I also used the correct Q code for the product.”

“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.”

“Can one appropriately bill a debridement code, such as CPT 11042, each time when applying a skin substitute if indicated in a hospital, outpatient wound care clinic?”