Health Information Management

Q&A: Where do we find skin substitute classifications?

APCs Insider, March 6, 2015

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Q: We use a lot of skin substitutes. Where do we find a list of the new HCPCS codes and how they are classified? We know how much we pay for them, but we are hoping there are specific guidelines for reporting with the correct procedure.
A: You can find this information in several places. One place is the quarterly OPPS and I/OCE update transmittals issued by CMS. Transmittal 3156 contains the information for the January update to the OPPS. In this transmittal, Table 5 lists the new HCPCS codes for skin substitutes along with the status indicator assigned for 2015. Table 7 in the same transmittal identifies those skin substitutes assigned to the low- and high-cost categories.
In addition, these assignments can be found in Transmittal 3153, which contains the changes to the I/OCE for 2015. Remember, you report the high-cost items with CPT® codes 15271-15278, and the low-cost items with HCPCS Level II codes C5271-C5278. 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.

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