Health Information Management

Q&A: We now receive edits on certain skin substitutes

APCs Insider, April 17, 2015

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Q: We have been reporting skin substitutes with the appropriate procedure codes (either CPT® or HCPCS C codes) with no problems. However, we are now receiving an edit that tells us we have a mismatch between the procedure code and the Q code for skin substitute such as Allowrap® and Dermavest™. What changed?
A: Beginning with the April OPPS update, CMS has reclassified these two products—Allowrap DS or Dry, 1 sq cm (Q4150) and Dermavest, 1 sq cm (Q4153)—from the low-cost category to the high-cost category of skin substitutes. The high-cost substitutes are reported with CPT codes. This change triggers the edit because, prior to April 1, these products were reported with HCPCS C codes.
Be sure that your department staff know to document in the patient’s record the amount of any skin substitute that is not used/wasted. CMS will allow reporting of the documented amount of these substances that are used and wasted. Without the specific documentation, the units may not be supported for reporting, as these codes are all based on one square centimeter.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

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