News You Can Use
UPDATE ON 2012 CPT CODES FOR WOUND CARE
There is good news for wound care practitioners with regard to wound debridement codes and skin substitute codes. The codes have been simplified and the RVUs have gone up! A recent article in the Bulletin of the American College of Surgeons summarized these changes.
Active Wound Care Management
- • Non-Selective Debridement: CPT 97602
- • Selective Debridement: CPT 97597, 97598 (>20cm2)
Excisional debridement (11042 – 11047) is defined as the sharp removal of tissue at the wound margin or at the wound base until viable tissue is removed. This involves the removal of necrotic tissue in addition to healthy viable tissue whose origin can be clearly. All surgical debridement codes include skin
- • 11042: Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); ≤ 20 cm2
- • +11045 each additional 20cm2
- • 11043: Debridement, muscle and/or fascia; ≤ 20 cm2
- • +11046 each additional 20cm2
- • 11044: Debridement, bone; ≤ 20 cm2
- • +11047 each additional 20cm2
A global period is a timeframe within which Medicare will not make additional payment for services provided to a patient related to the original procedure. Typically, these timeframes are either 10 or 90 days for “minor surgical procedures”, of which debridements are included.
- Global periods ONLY apply to the professional fee – they do NOT affect hospital technical reporting in the Outpatient department.
- There are NO global periods for either Selective (97597-97598) or Excisional (11042-11047) debridement.
SKIN REPLACEMENT SURGERY
Comprehensive changes have been made to the skin replacement surgery subsection. The changes include deletion of 24 codes, revision of six codes, and the creation of eight new codes (15271-15278). The codes include minimal wound bed preparation and the dressing. They are divided by anatomic location and size
Bioengineered alternative tissues may be cellular or acellular and may be applied in office setting
There may be limitations on number of applications and frequency – check with LCD
Positive Results For Phase IIb Trial Of
Unique Cell-based Therapy In Venous Leg Ulcers
FORT WORTH, TX, AUGUST 4, 2011 – Healthpoint Biotherapeutics today announced positive topline results for its Phase IIb clinical trial investigating the efficacy of HP802-247 in venous leg ulcers. HP802-247 is an investigational allogeneic living cell suspension containing keratinocytes and fibroblasts. The study was designed to determine the potential effectiveness of two cell concentrations and two dosing frequencies of HP802-247, when combined with standard care, compared to control plus standard care, in healing venous leg ulcers over a 12-week treatment period. The control in this trial was the self-assembling fibrin matrix that is part of the HP802-247 formulation, and which creates a provisional extracellular matrix in the wound.
For more information, click here to download the full press release.
New CPT codes and code changes for 2011
- excerpted from the American College of Surgeons monthly newsletter
The CPT section on Excision and Debridement has been revised to refer only to Debridement. All wound debridements are now reported by depth of tissue removed and by surface area of the wound. If debridement of a single wound is required, the deepest level of tissue removed is used to report the service. However, if multiple wound debridements are performed, sum the surface area of those wounds at the same tissue depth, but do not combine sums from different depths.
Codes 11040 and 11041, previously used to report debridement of partial or full thickness skin, have been deleted. To report debridement of skin (that is, dermis or epidermis), use the active wound care management codes 97597 and 97598.
Codes 11042, 11043, and 11044, previously used to report debridement of subcutaneous tissue, muscle, or bone, respectively, have been revised as well. These three codes are now used to report debridement of the first 20 sq cm or less of tissue, muscle, or bone. Three new add- on codes (11045, 11046, 11047) will be used to report each additional 20 sq cm, or part thereof, of subcutaneous tissue, muscle, or bone in con- junction with 11042, 11043, and 11044. Whenchoosing which codes to report, keep in mind that the CPT code numbers are in non-sequential order. The code pairs for the first 20 sq cm and each additional 20 sq cm are: 11042 with 11045, 11043 with 11046, and 11044 with 11047.
The active wound care management codes, 97597 and 97598, have also been revised to report the first 20 sq cm or less of total wound surface area (97597) and each additional 20 sq cm, or part thereof, of total wound surface area (97598).
The integumentary system subsection of CPT 2011 comprises numerous new, revised, and deleted codes; indeed, even the guidelines for their use have changed. The following example is intended to clarify the correct use of the new and revised debridement codes.
A young man who was rollerblading fell and suffered injuries to the palmar surface of both hands and the anterior aspect of his right leg. No bones were fractured. His right hand required minimal wound cleaning of a 4 cm x 4 cm area of erythematous epidermis. His left hand required debridement through the subcutaneous tissue of a 3 cm x 10 cm area. His right leg required debridement down to and including bone of a 5 cm x 10 cm area.
Reportable procedures for this example include the following:
• 97597, Debridement of skin, ie, epidermis and/or dermis, first 20 sq cm, right hand
• 11042-59-51, Debridement, subcutaneous tissue, first 20 sq cm, left hand
• +11045, Debridement, subcutaneous tissue, additional 20 sq cm, or part thereof, left hand
• 11044-59-51, Debridement, bone, first 20 sq cm, right leg
• +11047, Debridement, bone, each additional 20 sq cm, right leg
• +11047, Debridement, bone, each additional 20 sq cm, right leg
The procedure on his right hand involved debridement of epidermis. Revised codes 97597 and 97598 are used to report debridement of the first 20 sq cm of skin and each additional 20 sq cm of skin, respectively. Because only 16 sq cm of skin required debridement, only code 97597 would be reported.
The procedure on the left hand involved debridement of a 30 sq cm area of subcutaneous tissue. Code 11042 would be reported for the first 20 sq cm and add-on code 11045 would be reported for the remaining 10 sq cm of 30 sq cm total wound surface.
The procedure on his right leg included debridement of bone. Code 11044 would be re- ported for the first 20 sq cm, and add-on code 11047 would be reported twice for the second 20 sq cm and the remaining 10 sq cm of 50 sq cm total wound surface. Note that codes 11010– 11012 would not be correct because there was no fracture in either hands or the leg.
The debridement on the right hand and right leg were separate wounds at separate operative sites and depths, so modifier 59 (distinct procedural service) should be appended to the primary procedures 11042 and 11044. Additionally, some software edit packages may bundle these debridement codes together; therefore, it may also be appropriate to append modifier 51 (multiple procedure).
FDA requires that companies stop manufacturing products containing topical papain.
Historically, topical papain products were allowed to be marketed without FDA approval. However, in June 2006, the FDA ruled that pre-1962 drugs required approval and that those without approval would be removed in a risk-based approach. On September 23, 2008 the FDA announced that companies marketing topical drug products containing papain must stop manufacturing the products on or before Nov 23, 2008 and cannot be shipped in interstate commerce after January 21, 2009. This includes approximately 35 topical products used to treat wounds.
Rationale: From 1969 to January 2008 the FDA cites 37 reports of serious adverse events associated with use of topical papain products. These include anaphylactic shock and hypersensitivity to products containing papain, including meat tenderizer, contact lens solutions and adhesive removers. There is also cross reactivity between latex and papaya, creating a risk for patients with latex sensitivity. The FDA notes a lack of well controlled studies demonstrating efficacy of the products and therefore cannot assess whether the benefits outweigh the documented risks.
Click Here for more information on the FDA's decision.
Given that the WHS Guidelines recommend debridement as a critical aspect of wound bed preparation, the practitioner now has fewer options for chemical debridement. Currently the only FDA-approved enzyme for debridement is collagenase, derived from fermentation of Clostridium histolyticum. However, other choices including sharp, mechanical, autolytic and biological debridement remain and will likely see increased utilization. Additional scientific studies will clarify the relative efficacy of these choices for different types of wounds (and is the only way to ensure continued FDA and insurance company approval). Documentation of the medical necessity for debridement and the type of debridement will facilitate appropriate reimbursement.
Submitted by Lisa Gould, MD, PhD