Transcript

I'm Dr. Matthew Regulski, DPM, ABMSP, FFPM RCPS(Glasgow). I practice in Toms River, New Jersey at Ocean County Foot & Ankle Surgical Associates. This is coming up on my 20th year. I run the Wound program in that. There's 15 doctors in our program. I'm a fellow faculty in podiatric medicine from the Royal College of Physicians and Surgeons in Glasgow, Scotland, a diplomat and American board of multiple specialties in podiatry, and I have been doing wound healing 20 years. Thank you for having me.

What is a Q-code, and how does it apply to coding for application of cellular- and tissue-based products (CTPs)

Q-Codes are utilized for the skin substitute market. Now there are dehydrated dead tissues and there are living tissues in this realm, 212 skin substitutes in this market. But Q-Codes are for mostly your amnion products or your dehydrated, decellularized products, fish skin, all those types of substitutes is what the Q-Codes are for.

Now there are, again, a division. There's a high bucket. There's a low bucket for those, and that's up to you to decide which one of your skin substitutes fall into that category. But Q -Codes are utilized for the CTP products.

What is an A-code? How does it differ from a Q-code?

A-Codes are interesting because they are mostly for your new synthetic products. But they're also for your DME products. When I order different types of collagen and foams and alginates, they're also reimbursable under the A-Code. So, the A-Code now is synthetics and with DME reimbursable products where Q-Codes are for your cellular tissue -based products.

How should clinicians approach powdered or particulate CTPs from a coding standpoint?

In my system, you can have an A-Code for a collagen powder that you can order from a distributor. But, as far as the injectables go, they really have to be on formulary in your hospital because they're included in what's called the DRG. If you were to do a procedure in the hospital where you excised a wound out or took somebody to the OR and you would do that procedure, you would then have your injectable because those are highly regulated now and they took a lot of those off the market. And then you have your injectable to inject during that period when you're doing a procedure in the hospital.

As far as doing them privately in the office, I believe they've been removed from that. You may have to check and make sure they're on your formulary in your hospital, and use that in accordance with what surgical procedure you're doing. But the collagen powders are reimbursable. Those have an A-code that you can follow.

What else do you feel clinicians should know about these different types of codes?

It's very convoluted. You really need to understand when you're utilizing these in the private office, make sure you have excellent, excellent documentation to support your use for. And I think a lot of physicians can get into problems because they don't have proper documentation. Things like: how long the patients had it? What kind of treatments did you do on it prior? How is their blood flow? What is their hemoglobin A1C like, if they are diabetic? Do they smoke? What kind of nutrition do you have them on? For diabetic foot ulcers, how are they offloaded? For venous leg ulcers, are you using multi-layer compression? You have to include all of those things that you have done, prior treatments to it, diagnostics, etc. More information the better when you're utilizing this in the private office, or you could have a problem.

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