Transcript

My name is Dr. Jonathan Johnson, MD, MBA, CWSP. I am a board certified wound care provider and surgeon here in the Maryland, DC, and Virginia area.

I am the founder and president of Comprehensive Wound Care Services. We focus on taking care of patients in long-term care, assisted living, telemedicine, and virtual visits, our office, as well as hospital patients. We’re super excited to talk a little bit today about some of the advances in cellular tissue products and to make sure we stay within the standard of care with some of the new regulations that are out and about these days.

What are the types of billing codes that reflect the application of a cellular-and tissue-based product?

The different categories for codes that exist for cellular- and tissue-based products are focused on Q-codes. They also could be focused on A-codes. I think the number one thing that we need to understand is that a lot of the changes that could be apparent moving forward with CMS and some of the MACs are still kind of in fluid state. So we want to make sure that we're paying attention to the CMS and the MAC guidelines to make sure that the products that we are using are in compliance and are, quote unquote, "on the list of approved products at the specific MACs." And as far as the procedure, the cellular tissue product, the CPT code represent the entire process, the point of having the CPT is that you're applying the graft and that cellular tissue product and CPT should correlate with an ICD-10 diagnosis when you are applying that specific product.

What types of modifiers might apply to coding in these situations?

Modifiers can be used on your billing form when you are creating your billing form after scrubbing your note. There's 2 types of modifiers that can be used. And again, sometimes this information can be fluid based on what the MACs are requiring and which products are approved on these specific lists. You have a JW modifier, which means the amount of the cellular tissue product that is not used or "wasted" with a W. And then you have a JC. And the JC stands for the product that was actually used at the specific square centimeter meter that the graft was applied to based on the wound size. You have the size of the wound and you have the specific product that should correlate as close as possible to the graft's size. And there could be variations, obviously, because not every single wound is going to have the same exact square centimeter size as a specific graft, but there are times where some of the graft can be not used or not utilized, so the modifier would be a JC. And you want to make sure you're putting the exact square centimeter of the graft used and the exact square centimeter of the amount that was not used on your claim forms.

What key information should clinicians ascertain in order to properly code for application of a cellular- or tissue-based product?

One of the key pieces of information that all clinicians and billers need to have to make sure that they are properly coding the application of their cellular tissue products: number 1 is focusing, as we've said before in this talk, on the LCD, which is the local covered determinant. It's very important to look at which LCD correlates to the specific MAC in your region where you are treating patients. The LCD will lay out the guidelines and the standard of care for utilizing the cellular tissue products. For instance, if your note says that you have moderate drainage, that is a contraindication to utilizing a cellular tissue product. If the wound has active tunneling and undermining, or if there is an active cluster and a communication between 2 wounds, that is an active contraindication for graphing and utilizing the cellular tissue products. Again, each MAC will have an LCD that correlates to their specific standard of care when applying these specific cellular tissue products.

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The second is to devitalized tissue. Your note should not include anything related to slough, eschar, necrotic tissue, etc. Anything related to infection, callus, epibole, changes at the period wound, all of these can be contraindications to applying the cellular tissue graft and your CPT. Again, focus on the LCD which is correlated to the specific MAC in the region where you are treating your patients.

What other aspects of CTP application coding do you feel clinicians should be aware of?

Again, the most important concept, if you don't remember anything else we've said today, and I hope you do remember as much as what we said today, is that understand and read thoroughly your LCD.

From a practice standpoint, the clinicians and the billers and the coders and whoever you're working with that is submitting your claims to the clearinghouse, which then goes to the payers, need to be on the same page as far as:

• Has the wound changed in size?
• Is there a clinical need and a standard of care to apply the cellular tissue product?
• Has the wound failed to progress after the standard of care for multiple weeks, anything between 4 and 6 weeks, and anything after that where the wound has continuously not improved or shown a decline? 

These are specific indications that do allow you to use cellular tissue products. Again, the most important thing is to focus on what the LCD is explaining and "approving" based on the MAC in your specific region. Again, you can go to cms.gov, you can look up your specific MAC and there's an LCD attached to that specific MAC that lays out the standard of care and what is approved when applying these specific cellular tissue products.

I would just like to say that in our wound care atmosphere and in our practice now, we want to make sure we are adequately and using the standard of care to apply our cellular tissue products correctly. We want to make sure we're staying "within the standard of care" when we're applying the cellular tissue products to make sure that the patients are benefiting number 1, and number 2 to make sure our future patients and patients that we will be able to treat in the future can continue to have these extremely vital and important standard of care based practices as cellular tissue products to help our chronic and sometimes acute wounds heal.

Information regarding coding, coverage, and payment is provided as a service to our audience. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.