Reimbursement Guide - MLM Biologics · 2019-05-18 · Reimbursement Guide bio-ConneKt® Wound Matrix For the Treatment of ... CPT™ (Current Procedural Terminology) and ICD-10 PCS

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Reimbursement Guide

bio-ConneKt® Wound Matrix

For the Treatment of Chronic Wounds April 2017

bio-ConneKt® Wound Matrix is an all-biologic, xenograft (equine) collagen-based scaffold that is

clinically indicated for the local management of moderately to heavily exuding wounds including partial

and full thickness wounds, draining & tunneling wounds, pressure sores/ulcers, venous ulcers, chronic

vascular ulcers, diabetic ulcers, trauma wounds (e.g. abrasions, lacerations, partial thickness burns, skin

tears), and surgical wounds (e.g. donor sites/grafts, post-laser surgery, post-Moh’s surgery, podiatric

wounds, dehisced surgical incisions). The product is covered by primary and secondary wound dressings

to help keep the wound site clean and prevent infections. Clinical testing results indicate no need for

product removal of bio-ConneKt® and one-time application for most conditions. bio-ConneKt® Wound

Matrix was cleared for marketing by the FDA in July, 2014 and is available to wound care professionals

in multiple treatment sizes.

HCPCS, CPT™ and ICD-10 PCS Coding

HCPCS (Healthcare Common Procedure Code System), CPT™ (Current Procedural Terminology) and

ICD-10 PCS (International Classification of Diseases, Version 10, Procedure Code System) codes are

broadly used to describe bio-ConneKt Wound Matrix and the manner in which it is used in the treatment

of chronic wounds, burns and skin replacement surgery. The following coding options are applicable to

services provided in the hospital, ambulatory surgery center (ASC) and physician office setting.

Skin Replacement Surgery (CPT codes 15002- 15005)

These are used by physicians, hospital outpatient departments and ambulatory surgery centers.

15002 - Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including

subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq. cm or 1% of body area

of infants and children

+ 15003 - each additional 100 sq. cm, or part thereof, or each additional 1% of body area of infants and

children (List separately in addition to code for primary procedure)

+ Q4161 – bio-ConneKt Wound Matrix, per square centimeter

15004 - Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including

subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits,

genitalia, hands, feet and/or multiple digits; first 100 sq. cm or 1% of body area of infants and children

+15005 - each additional 100 sq. cm, or part thereof, or each additional 1% of body area of infants and

children (List separately in addition to code for primary procedure)


These codes are not intended to be reported for simple graft application alone or application stabilized

with dressings (e.g., by simple gauze wrap). The bio-ConneKt® graft is anchored using the surgeon's

choice of fixation. Routine dressing supplies are not reported separately.

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Treatment of Chronic Wound and Burns (CPT and Special “C” Codes)

These are the CPT codes billed by the physician regardless where s(he) provides the care. If

provided in a hospital or ASC, the physician does not bill for bio-ConneKt.

When used as a bioengineered skin substitute, treatments using bio-ConneKt® are reported under

different procedure codes for physicians and hospitals. This also varies for hospitals if the patient is

treated as an inpatient or outpatient. For physicians the correct CPT code range is 15271-15278 for

topical application to a wound surface when provided in a physician office setting. The use of bio-

ConneKt® is reported with its own HCPCS code (Q4161) in addition to the appropriate CPT code.

Please see the examples below.

15271 - Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq. cm; first 25 sq.

cm or less wound surface area

+ 15272 - each additional 25 sq. cm wound surface area, or part thereof (List separately in addition to code

for primary procedure)


15273 - Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100

sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children

+ 15274 - each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body

area of infants and children, or part thereof (List separately in addition to code for primary procedure)


15275 - Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet,

and/or multiple digits, total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface area




15277 - Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet,

and/or multiple digits, total wound surface area greater than or equal to 100 sq. cm; first 100 sq. cm wound surface

area, or 1% of body area of infants and children




(Note: CPT codes 15040–15261 are for Tissue Cultured Autograft and do not apply to use of bio-ConneKt.)

bio-ConneKt® Wound Matrix is supplied dry and stored at room temperature. It is double pouch

packaged and provided in a final outer cardboard envelope. The product is supplied in four different

sizes: 6 cm x 7 cm (42 sq. cm); 5 cm x 5 cm (25 sq. cm); 3 cm x 3 cm (9 sq. cm); and 2 cm x 2 cm (4 sq.

cm). bio-ConneKt® Wound Matrix is supplied sterile and subject to proprietary processing to withstand

challenges of wound micro-environment. This information is provided in a product brochure which is

included in each package.

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Medicare assumes that physicians make good faith efforts to minimize the unused portion of bio-ConneKt

when ordering, storing and applying the product in their clinical practice. Therefore, Medicare (and most

private payers) will cover the amount of product that is discarded along with the amount used to treat the

wound. Any discarded material should be documented in the patient medical record with the date and

location of wound, amount of product used, amount discarded, and reason for the wastage and

manufacturers serial/lot/batch number for the product.

Note: Some Medicare Administrative Contractors require discarded materials to be reported

separately from the medically necessary material. In these instances, the Modifier “JW” should be

appended to the HCPCS code with the number of sq. cm. and cost of bio-ConneKt® that is discarded.

Providers should check with their local Medicare Administrative Contractor.

These 4 primary codes are used by the HOSPITALS or the AMBULATORY SURGERY

CENTERS for the billing of specific services with bio-ConneKt Wound Matrix when used as

outpatients. Surgeons would bill the same CPT codes, but not the “Q” code for bio-ConneKt

Wound Matrix in these places of service.

Effective April 1, 2017, the Centers for Medicare & Medicaid Services (CMS) has re-assigned bio-

ConneKt Wound Matrix to the HIGH COST category for bioengineered skin products. 15271 - Application of high cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq. cm;

first 25 sq. cm or less wound surface area




15273 - Application of high cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or

equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children




15275 - Application of high cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia,

hands, feet, and/or multiple digits, total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface

area




15277 - Application of high cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia,

hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq. cm; first 100 sq. cm

wound surface area, or 1% of body area of infants and children




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OUTPATIENT HOSPITAL AND ASC PAYMENTS

Medicare employs different payment methodologies and different payment amounts to physicians,

hospitals and ASCs for Skin Replacement Surgery and the treatment of Chronic Wounds.

• Physicians will be paid under the RBRVS system for their professional services. The cost of bio-

ConneKt® is paid in addition to the professional service when coded and charged as a line item

expense. Physicians are to report the amount of product they used.

• Under the Hospital Outpatient Prospective Payment System Medicare pays hospitals according to

the APC (Ambulatory Payment Classification) methodology. ASC payments are on based on

reported CPT codes. The chart below shows how these provider types are paid. The Medicare

allowances cited are national averages for the period beginning January 1, 2016.

Procedure Code Hospital ASC

Skin Replacement Surgery 15002/15003 $1,427.212 $ 771.98

15004/15005 $ 428.671 $ 244.98

Chronic Wound Care 15271/15272 $1,427.212 $ 771.98

15273/15274 $2,504.003 $1,354.26

15275/15276 $1,427.001 $ 771.98

15277/15278 $1,427.002 $ 771.98

1APC #5053 – Level III Skin Procedures

2APC #5054 – Level IV Skin Procedures

3APC #5055 – Level V Skin Procedures

In each circumstance, Medicare’s allowance for the cost of bio-ConneKt® Wound Matrix is included in

the payments cited above regardless of the size of the wound or the amount of product used. Private

insurer payment methodologies and payment levels will vary from Medicare. Providers should contact

their primary private payers to understand any unique coverage and payment circumstances.

Inpatient Hospital Payment

The most common DRGs (Diagnosis Related Groups) to which skin replacement and chronic wound

repair surgeries will be assigned for payment when a patient needs to be hospitalized are as follows.

MS

DRG

Descriptor

Medicare

Allowance*

463 Wound Debride & Skin Graft Exc Hand, For Musculo-Conn Tiss Dis w MCC $29,291

464 Wound Debride & Skin Graft Exc Hand, For Musculo-Conn Tiss Dis w CC $16,597

465 Wound Debride & Skin Graft Exc Hand, For Musculo-Conn Tiss Dis w/o CC/MCC $11,124

573 Skin Graft For Skin Ulcer Or Cellulitis w MCC $20,070

574 Skin Graft For Skin Ulcer Or Cellulitis w CC $15,551

575 Skin Graft For Skin Ulcer Or Cellulitis w/o CC/MCC $ 8,051

576 Skin Graft Exc For Skin Ulcer Or Cellulitis w MCC $23,513

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577 Skin Graft Exc For Skin Ulcer Or Cellulitis w CC $12,459

578 Skin Graft Exc For Skin Ulcer Or Cellulitis w/o CC/MCC $ 7,529

622 Skin Grafts & Wound Debrid For Endoc, Nutrit & Metab Dis w MCC $20,038

623 Skin Grafts & Wound Debrid For Endoc, Nutrit & Metab Dis w CC $10,315

624 Skin Grafts & Wound Debrid For Endoc, Nutrit & Metab Dis w/o CC/MCC $ 5,836

904 Skin Grafts For Injuries w CC/MCC $17,758

905 Skin Grafts For Injuries w/o CC/MCC $ 7,510

906 Hand Procedures For Injuries $ 8,185

˚ Medicare Allowances are National Averages for 2017 without regional or DPH adjustments.

ICD-10 PROCEDURE AND DIAGNOSIS CODES

ICD-10 CM (Diagnosis Codes). Hospitals and physicians were required to begin reporting ICD-10

diagnosis codes beginning October 1, 2015. This conversion has provided significantly greater specificity

in the reporting of all medical and surgical conditions. For a period of 12 months after implementation of

ICD-10, Medicare will not deny physician or other professional service claims billed under the Part B

physician fee schedule based solely on the specificity of the ICD-10 diagnosis code as long as the

physician/practitioners used a valid code from the “right family.” There is no such forgiveness, though,

for hospitals who should provide the greatest level of detail possible when reporting ICD codes for both

procedures and diagnoses.

Appendix A of this Reimbursement Guide contains a list of the most commonly reported ICD-10

diagnosis codes for the use of bioengineered skin substitutes/cellular or tissue-based products in the

treatment of chronic wounds and burns.

ICD-10 PCS (Procedure Codes). All government and private payers require hospitals to bill procedures

using the new ICD-10 PCS for inpatient admissions. This version provides about 10 times as many

procedure codes as version ICD-9. Appendix B of this Reimbursement Guide provides a crosswalk list of

CPT codes to ICD-10 PCS codes that are suitable for hospital billing.

MEDICARE AND PRIVATE PAYER COVERAGE

HCPCS, CPT™ and ICD-10 coding is universal, however, coverage of medical and surgical services can

vary widely among government (Medicare, Medicaid, TRICARE) and private health insurance

companies. As of this date, bio-ConneKt Wound Matrix is covered in all Medicare Administrative

jurisdictions in every state, except in Alabama, Georgia, and Tennessee which is administered by Cahaba

Government Benefit Administrators. Providers in these states are encouraged to check for changes

periodically as Medicare coverage positions can change from time-to-time. Private health insurers make

coverage decisions separately from Medicare. Providers should check with their local private insurers

periodically to ensure bio-ConneKt Wound Matrix is covered for their patients.

____________________________________

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SAMPLE LETTER OF MEDICAL NECESSITY

Some payers may require a healthcare provider to provide a letter of medical necessity to obtain prior authorization

or to accompany a claim to justify payment. When providing such a letter, the provider should include information

in the letter of medical necessity that supports the decision to apply bio-ConneKt® Wound Matrix to the patient.

The letter should include information on the severity of the wound, previous medications and treatments tried and

their outcome, impact upon the patient’s quality of life, and the provider’s past clinical experience with the product.

Below is a sample letter of medical necessity for the application of bio-ConneKt® Wound Matrix. This is a sample

only and should be modified as necessary to be accurate and to fit each patient’s specific situation.

(Please type on physician letterhead)

{Insert date}

Patient Name: { }

Patient Date of Birth: { }

Insurance Identification No.: { }

Physician Name: { }

Tax ID/NPI/Provider No.: { }

Projected Surgery Date: { }

Dear {insert payer name}:

The above-named patient has been diagnosed with {insert diagnosis description}, diagnosis code {insert

ICD-10 code} and is being recommended for a skin graft procedure using bio-ConneKt® Wound Matrix.

By this letter, I am seeking your pre-authorization for this procedure and for the use of this specific skin

substitute product for {insert patient name}.

{Medical Necessity of the Treatment: This may require 2 to 3 sentences. Document the patient’s current

findings/status, document chronological history, and recommend.} I have discussed the use of bio-

ConneKt® Wound Matrix with the patient and have recommended this product because of past successes

in my practice treating similar chronic wounds. bio-ConneKt® Wound Matrix {HCPCS Q4161 - bio-

ConneKt® Wound Matrix, per square centimeter} is a skin graft substitute constituted of Type I collagen

that is subsequently stabilized to prevent pre-mature enzymatic degradation. The product has proven

more effective than others in its class and is relatively low in cost. It is for these reasons that Medicare

covers bio-ConneKt® Wound Matrix through (name of local MAC) in (name of State). This procedure

and product are the best options we have for restoring this patient’s health. I request written confirmation

that this therapy is a covered benefit based on medical necessity and that associated institutional,

professional and product fees for the surgery will be covered.

Thank you for your prompt review of this information and for your pre-authorization. If you have any

questions, please contact me.

Sincerely,

{Physician name}

Enclosures:

bio-ConneKt® Wound Matrix Instructions for Use

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Company Information

MLMBiologics is a Delaware C-Corp company founded on the modern interpretation of Gandhian Economic

Principle of "More for Less for Many." The company's plans and projects are centered around developing, manufacturing and commercializing medical devices primarily on a biologics platform, that are effective both clinically (evidence and market driven) and financially (cost competitive), and have the opportunity to serve the needs of masses of patients worldwide using non-conventional marketing and sales distribution strategies. The company is privately held and operates out of Gainesville/Alachua in Florida.

______________________________________________

The information in this reimbursement guide is provided to assist hospitals and physicians in understanding the

reimbursement process for services involving the use of bio-ConneKt® Wound Matrix. Providers are responsible

for all coding and billing decisions and we strongly recommend you consult your payer organizations with regard to

local coverage and payment policies. The information contained in this document is provided for information

purposes only and represents no guarantee concerning coverage or levels of payment. Similarly, all CPT™ , ICD-

10 CM™ and PCS codes reflect consensus opinions of certified professional coders and are supplied for information

purposes only. Nothing in this document should be viewed as instructions for selecting any particular code. The

information contained herein is not intended to state or imply in any way that bio-ConneKt® has been cleared by the

FDA for any more specific use, and is not intended to state or imply that any payer will cover the use of bio-

ConneKt® for any specific surgical application.

Reimbursement Support Contact Information

This 2016 Reimbursement Guide was created for the benefit of clinicians and hospitals. For providers with coding

or payment questions related to this guide, please email [email protected] or call 651.337.8171.

Any five-digit numeric codes, service descriptions, instructions or guidelines from the Current Procedural

Terminology® (CPT) are copyright of the American Medical Association. The AMA assumes no responsibility for

consequences attributable to or related to any use or interpretation of any information or views contained or not

contained in this document.

______________________________________________

mailto:[email protected]

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Appendix A

ICD-10 CM Diagnosis Codes for

Chronic Wound Care Based on Most Commonly Covered Conditions

VARICOSE VEINS

I83.011 Varicose veins of right lower extremity with ulcer of thigh

I83.012 Varicose veins of right lower extremity with ulcer of calf

I83.013 Varicose veins of right lower extremity with ulcer of ankle

I83.014 Varicose veins of right lower extremity with ulcer of heel and midfoot

I83.015 Varicose veins of right lower extremity with ulcer other part of foot

I83.018 Varicose veins of right lower extremity with ulcer other part of lower leg

I83.021 Varicose veins of left lower extremity with ulcer of thigh

I83.022 Varicose veins of left lower extremity with ulcer of calf

I83.023 Varicose veins of left lower extremity with ulcer of ankle

I83.024 Varicose veins of left lower extremity with ulcer of heel and midfoot

I83.025 Varicose veins of left lower extremity with ulcer other part of foot

I83.028 Varicose veins of left lower extremity with ulcer other part of lower leg

I83.211 Varicose veins of right lower extremity with both ulcer of thigh and inflammation

I83.212 Varicose veins of right lower extremity with both ulcer of calf and inflammation

I83.213 Varicose veins of right lower extremity with both ulcer of ankle and inflammation

I83.214 Varicose veins of right lower extremity with both ulcer of heel and midfoot and inflammation

I83.215 Varicose veins of right lower extremity with both ulcer other part of foot and inflammation

I83.218 Varicose veins of right lower extremity with both ulcer of other part of lower extremity and inflammation

I83.221 Varicose veins of left lower extremity with both ulcer of thigh and inflammation

I83.222 Varicose veins of left lower extremity with both ulcer of calf and inflammation

I83.223 Varicose veins of left lower extremity with both ulcer of ankle and inflammation

I83.224 Varicose veins of left lower extremity with both ulcer of heel and midfoot and inflammation

I83.225 Varicose veins of left lower extremity with both ulcer other part of foot and inflammation

I83.228 Varicose veins of left lower extremity with both ulcer of other part of lower extremity and inflammation

I87.001 Postthrombotic syndrome without complications of right lower extremity

I87.002 Postthrombotic syndrome without complications of left lower extremity

I87.003 Postthrombotic syndrome without complications of bilateral lower extremity

I87.011 Postthrombotic syndrome with ulcer of right lower extremity

I87.012 Postthrombotic syndrome with ulcer of left lower extremity

I87.013 Postthrombotic syndrome with ulcer of bilateral lower extremity

I87.2 Venous insufficiency (chronic) (peripheral)

ATHEROSCLEROSIS

I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower right leg

I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh

I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf

I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle

I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot

I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot

I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg

I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh

I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf

I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle

I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot

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I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot

I70.438 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of lower leg

I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh

I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf

I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle

I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot

I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot

I70.448 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of lower leg

I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh

I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf

I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle

I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot

I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot

I70.538 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of lower leg

I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh

I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf

I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle

I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot

I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot

I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh

I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf

I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle

I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot

I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot

I70.638 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of lower leg

I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh

I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf

I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle

I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot

I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot

I70.648 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of lower leg

I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh

I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf

I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle

I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot

I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot

I70.738 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of lower leg

I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh

I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf

I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle

I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot

I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot

I70.748 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of lower leg

NON-PRESSURE CHRONIC ULCER

L97.111 Non-pressure chronic ulcer of right thigh limited to breakdown of skin

L97.112 Non-pressure chronic ulcer of right thigh with fat layer exposed

L97.113 Non-pressure chronic ulcer of right thigh with necrosis of muscle

L97.114 Non-pressure chronic ulcer of right thigh with necrosis of bone

L97.121 Non-pressure chronic ulcer of left thigh limited to breakdown of skin

L97.122 Non-pressure chronic ulcer of left thigh with fat layer exposed

L97.123 Non-pressure chronic ulcer of left thigh with necrosis of muscle

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L97.124 Non-pressure chronic ulcer of left thigh with necrosis of bone

L97.211 Non-pressure chronic ulcer of right calf limited to breakdown of skin

L97.212 Non-pressure chronic ulcer of right calf with fat layer exposed

L97.213 Non-pressure chronic ulcer of right calf with necrosis of muscle

L97.214 Non-pressure chronic ulcer of right calf with necrosis of bone

L97.221 Non-pressure chronic ulcer of left calf limited to breakdown of skin

L97.222 Non-pressure chronic ulcer of left calf with fat layer exposed

L97.223 Non-pressure chronic ulcer of left calf with necrosis of muscle

L97.224 Non-pressure chronic ulcer of left calf with necrosis of bone

L97.311 Non-pressure chronic ulcer of right ankle limited to breakdown of skin

L97.312 Non-pressure chronic ulcer of right ankle with fat layer exposed

L97.313 Non-pressure chronic ulcer of right ankle with necrosis of muscle

L97.314 Non-pressure chronic ulcer of right ankle with necrosis of bone

L97.321 Non-pressure chronic ulcer of left ankle limited to breakdown of skin

L97.322 Non-pressure chronic ulcer of left ankle with fat layer exposed

L97.323 Non-pressure chronic ulcer of left ankle with necrosis of muscle

L97.324 Non-pressure chronic ulcer of left ankle with necrosis of bone

L97.411 Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of skin

L97.412 Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed

L97.413 Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle

L97.414 Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone

L97.421 Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin

L97.422 Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed

L97.423 Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle

L97.424 Non-pressure chronic ulcer of left heel and midfoot with necrosis of bone

L97.511 Non-pressure chronic ulcer of other part of right foot limited to breakdown of skin

L97.512 Non-pressure chronic ulcer of other part of right foot with fat layer exposed

L97.513 Non-pressure chronic ulcer of other part of right foot with necrosis of muscle

L97.514 Non-pressure chronic ulcer of other part of right foot with necrosis of bone

L97.521 Non-pressure chronic ulcer of other part of left foot limited to breakdown of skin

L97.522 Non-pressure chronic ulcer of other part of left foot with fat layer exposed

L97.523 Non-pressure chronic ulcer of other part of left foot with necrosis of muscle

L97.524 Non-pressure chronic ulcer of other part of left foot with necrosis of bone

L97.811 Non-pressure chronic ulcer of other part of right lower leg limited to breakdown of skin

L97.812 Non-pressure chronic ulcer of other part of right lower leg with fat layer exposed

L97.813 Non-pressure chronic ulcer of other part of right lower leg with necrosis of muscle

L97.814 Non-pressure chronic ulcer of other part of right lower leg with necrosis of bone

L97.821 Non-pressure chronic ulcer of other part of left lower leg limited to breakdown of skin

L97.822 Non-pressure chronic ulcer of other part of left lower leg with fat layer exposed

L97.823 Non-pressure chronic ulcer of other part of left lower leg with necrosis of muscle

L97.824 Non-pressure chronic ulcer of other part of left lower leg with necrosis of bone

DIABETES

E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified

E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy

E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy

E08.43 Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy

E08.49 Diabetes mellitus due to underlying condition with other diabetic neurological complication

E08.51 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene

E08.52 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene

E08.610 Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy

E09.40 Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified

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E09.41 Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy

E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy

E09.43 Drug or chemical induced diabetes mellitus w/neurological complications with diabetic autonomic (poly)neuropathy

E09.49 Drug or chemical induced diabetes mellitus w/neurological complications w/ other diabetic neurological complication

E09.51 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene

E09.52 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene

E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified

E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy

E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy

E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy

E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene

E10.59 Type 1 diabetes mellitus with other circulatory complications

E10.621 Type 1 diabetes mellitus with foot ulcer E10.622 Type 1 diabetes mellitus with other skin ulcer

E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified

E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy

E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene

E11.59 Type 2 diabetes mellitus with other circulatory complications

E11.621 Type 2 diabetes mellitus with foot ulcer

E11.622 Type 2 diabetes mellitus with other skin ulcer

E11.69 Type 2 diabetes mellitus with other specified complication

E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified

E13.41 Other specified diabetes mellitus with diabetic mononeuropathy

E13.42 Other specified diabetes mellitus with diabetic polyneuropathy

E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy

E13.44 Other specified diabetes mellitus with diabetic amyotrophy

E13.49 Other specified diabetes mellitus with other diabetic neurological complication

E13.51 Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene

E13.59 Other specified diabetes mellitus with other circulatory complications

E13.621 Other specified diabetes mellitus with foot ulcer E13.622 Other specified diabetes mellitus with other skin ulcer

Appendix B

ICD-10 PCS Codes for

Chronic Wound Care (CPT 15271 – 15278)

CPT #15271, #15272, #15273 and #15274 Conversion to ICD-10 PCS 0HR5XJ3 Replacement of Chest Skin with Synthetic Substitute, Full Thickness, External Approach

0HR5XJ4 Replacement of Chest Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR5XJZ Replacement of Chest Skin with Synthetic Substitute, External Approach

0HR5XK3 Replacement of Chest Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HR5XK4 Replacement of Chest Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HR6XJ3 Replacement of Back Skin with Synthetic Substitute, Full Thickness, External Approach

0HR6XJ4 Replacement of Back Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR6XJZ Replacement of Back Skin with Synthetic Substitute, External Approach

0HR5XJ3 Replacement of Chest Skin with Synthetic Substitute, Full Thickness, External Approach

0HR5XJ4 Replacement of Chest Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR5XJZ Replacement of Chest Skin with Synthetic Substitute, External Approach

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HR5XJ3&_a=view


https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HR5XJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HR5XK3&_a=view








12

0HR5XK3 Replacement of Chest Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HR5XK4 Replacement of Chest Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HR8XJ3 Replacement of Buttock Skin with Synthetic Substitute, Full Thickness, External Approach

0HR8XJ4 Replacement of Buttock Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR8XJZ Replacement of Buttock Skin with Synthetic Substitute, External Approach

0HR8XK3 Replacement of Buttock Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HR8XK4 Replacement of Buttock Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HRBXJ3 Replacement of Right Upper Arm Skin with Synthetic Substitute, Full Thickness, External Approach

0HRBXJ4 Replacement of Right Upper Arm Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRBXJZ Replacement of Right Upper Arm Skin with Synthetic Substitute, External Approach

0HRBXK3 Replacement of Right Upper Arm Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HRBXK4 Replacement of Right Upper Arm Skin with Nonautologous Tissue Substitute, Partial Thickness, Ext Approach

0HRCXJ3 Replacement of Left Upper Arm Skin with Synthetic Substitute, Full Thickness, External Approach

0HRCXJ4 Replacement of Left Upper Arm Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRCXJZ Replacement of Left Upper Arm Skin with Synthetic Substitute, External Approach

0HRCXK3 Replacement of Left Upper Arm Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HRCXK4 Replacement of Left Upper Arm Skin with Nonautologous Tissue Substitute, Partial Thickness, Ext Approach

0HRDXJ3 Replacement of Right Lower Arm Skin with Synthetic Substitute, Full Thickness, External Approach

0HRDXJ4 Replacement of Right Lower Arm Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRDXJZ Replacement of Right Lower Arm Skin with Synthetic Substitute, External Approach

0HRDXK3 Replacement of Right Lower Arm Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HRDXK4 Replacement of Right Lower Arm Skin with Nonautologous Tissue Substitute, Partial Thickness, Ext Approach

0HREXJ3 Replacement of Left Lower Arm Skin with Synthetic Substitute, Full Thickness, External Approach

0HREXJ4 Replacement of Left Lower Arm Skin with Synthetic Substitute, Partial Thickness, External Approach

0HREXJZ Replacement of Left Lower Arm Skin with Synthetic Substitute, External Approach

0HREXK3 Replacement of Left Lower Arm Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HREXK4 Replacement of Left Lower Arm Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HRHXJ3 Replacement of Right Upper Leg Skin with Synthetic Substitute, Full Thickness, External Approach

0HRHXJ4 Replacement of Right Upper Leg Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRHXJZ Replacement of Right Upper Leg Skin with Synthetic Substitute, External Approach

0HRHXK3 Replacement of Right Upper Leg Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HRHXK4 Replacement of Right Upper Leg Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HRJXJ3 Replacement of Left Upper Leg Skin with Synthetic Substitute, Full Thickness, External Approach

0HRJXJ4 Replacement of Left Upper Leg Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRJXJZ Replacement of Left Upper Leg Skin with Synthetic Substitute, External Approach

0HRJXK3 Replacement of Left Upper Leg Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HRJXK4 Replacement of Left Upper Leg Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HRKXJ3 Replacement of Right Lower Leg Skin with Synthetic Substitute, Full Thickness, External Approach

0HRKXJ4 Replacement of Right Lower Leg Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRKXJZ Replacement of Right Lower Leg Skin with Synthetic Substitute, External Approach

0HRKXK3 Replacement of Right Lower Leg Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HRKXK4 Replacement of Right Lower Leg Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HRLXJ3 Replacement of Left Lower Leg Skin with Synthetic Substitute, Full Thickness, External Approach

0HRLXJ4 Replacement of Left Lower Leg Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRLXJZ Replacement of Left Lower Leg Skin with Synthetic Substitute, External Approach

0HRLXK3 Replacement of Left Lower Leg Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HRLXK4 Replacement of Left Lower Leg Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HRT0JZ Replacement of Right Breast with Synthetic Substitute, Open Approach

0HRT0KZ Replacement of Right Breast with Nonautologous Tissue Substitute, Open Approach

0HRTXJZ Replacement of Right Breast with Synthetic Substitute, External Approach 0HRTXKZ Replacement of Right Breast with Nonautologous Tissue Substitute, External Approach 0HRU0JZ Replacement of Left Breast with Synthetic Substitute, Open Approach 0HRU0KZ Replacement of Left Breast with Nonautologous Tissue Substitute, Open Approach 0HRUXJZ Replacement of Left Breast with Synthetic Substitute, External Approach 0HRUXKZ Replacement of Left Breast with Nonautologous Tissue Substitute, External Approach 0HRV0JZ Replacement of Bilateral Breast with Synthetic Substitute, Open Approach








https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRBXJ3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRBXJ4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRBXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRBXK3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRBXK4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRCXJ3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRCXJ4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRCXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRCXK3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRCXK4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRDXJ3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRDXJ4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRDXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRDXK3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRDXK4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HREXJ3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HREXJ4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HREXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HREXK3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HREXK4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRHXJ3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRHXJ4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRHXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRHXK3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRHXK4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRJXJ3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRJXJ4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRJXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRJXK3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRJXK4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRKXJ3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRKXJ4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRKXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRKXK3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRKXK4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRLXJ3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRLXJ4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRLXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRLXK3&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRLXK4&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRT0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRT0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRTXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRTXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRU0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRU0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRUXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRUXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRV0JZ&_a=view

13

0HRV0KZ Replacement of Bilateral Breast with Nonautologous Tissue Substitute, Open Approach 0HRVXJZ Replacement of Bilateral Breast with Synthetic Substitute, External Approach 0HRVXKZ Replacement of Bilateral Breast with Nonautologous Tissue Substitute, External Approach 0HRW0JZ Replacement of Right Nipple with Synthetic Substitute, Open Approach 0HRW0KZ Replacement of Right Nipple with Nonautologous Tissue Substitute, Open Approach 0HRWXJZ Replacement of Right Nipple with Synthetic Substitute, External Approach 0HRWXKZ Replacement of Right Nipple with Nonautologous Tissue Substitute, External Approach

0HRX0JZ Replacement of Left Nipple with Synthetic Substitute, Open Approach

0HRX0KZ Replacement of Left Nipple with Nonautologous Tissue Substitute, Open Approach

0HRXXJZ Replacement of Left Nipple with Synthetic Substitute, External Approach

0HRXXKZ Replacement of Left Nipple with Nonautologous Tissue Substitute, External Approach

CPT #15275 and #15276 Conversion to ICD-10 PCS 08RN0JZ Replacement of Right Upper Eyelid with Synthetic Substitute, Open Approach

08RN0KZ Replacement of Right Upper Eyelid with Nonautologous Tissue Substitute, Open Approach 08RNXJZ Replacement of Right Upper Eyelid with Synthetic Substitute, External Approach 08RNXKZ Replacement of Right Upper Eyelid with Nonautologous Tissue Substitute, External Approach 08RP0JZ Replacement of Left Upper Eyelid with Synthetic Substitute, Open Approach 08RP0KZ Replacement of Left Upper Eyelid with Nonautologous Tissue Substitute, Open Approach 08RPXJZ Replacement of Left Upper Eyelid with Synthetic Substitute, External Approach 08RPXKZ Replacement of Left Upper Eyelid with Nonautologous Tissue Substitute, External Approach 08RQ0JZ Replacement of Right Lower Eyelid with Synthetic Substitute, Open Approach 08RQ0KZ Replacement of Right Lower Eyelid with Nonautologous Tissue Substitute, Open Approach

08RQXJZ Replacement of Right Lower Eyelid with Synthetic Substitute, External Approach

08RQXKZ Replacement of Right Lower Eyelid with Nonautologous Tissue Substitute, External Approach

08RR0JZ Replacement of Left Lower Eyelid with Synthetic Substitute, Open Approach

08RR0KZ Replacement of Left Lower Eyelid with Nonautologous Tissue Substitute, Open Approach

08RRXJZ Replacement of Left Lower Eyelid with Synthetic Substitute, External Approach

08RRXKZ Replacement of Left Lower Eyelid with Nonautologous Tissue Substitute, External Approach

08UN0JZ Supplement Right Upper Eyelid with Synthetic Substitute, Open Approach

08UN0KZ Supplement Right Upper Eyelid with Nonautologous Tissue Substitute, Open Approach

08UNXKZ Supplement Right Upper Eyelid with Nonautologous Tissue Substitute, External Approach

08UP0KZ Supplement Left Upper Eyelid with Nonautologous Tissue Substitute, Open Approach

08UPXKZ Supplement Left Upper Eyelid with Nonautologous Tissue Substitute, External Approach

08UQ0KZ Supplement Right Lower Eyelid with Nonautologous Tissue Substitute, Open Approach

08UQXKZ Supplement Right Lower Eyelid with Nonautologous Tissue Substitute, External Approach

08UR0KZ Supplement Left Lower Eyelid with Nonautologous Tissue Substitute, Open Approach

08URXKZ Supplement Left Lower Eyelid with Nonautologous Tissue Substitute, External Approach

09R00JZ Replacement of Right External Ear with Synthetic Substitute, Open Approach

09R00KZ Replacement of Right External Ear with Nonautologous Tissue Substitute, Open Approach

09R0XJZ Replacement of Right External Ear with Synthetic Substitute, External Approach

09R0XKZ Replacement of Right External Ear with Nonautologous Tissue Substitute, External Approach

09R10JZ Replacement of Left External Ear with Synthetic Substitute, Open Approach

09R10KZ Replacement of Left External Ear with Nonautologous Tissue Substitute, Open Approach

09R1XJZ Replacement of Left External Ear with Synthetic Substitute, External Approach

09R1XKZ Replacement of Left External Ear with Nonautologous Tissue Substitute, External Approach

09R20JZ Replacement of Bilateral External Ear with Synthetic Substitute, Open Approach

09R20KZ Replacement of Bilateral External Ear with Nonautologous Tissue Substitute, Open Approach

09R2XJZ Replacement of Bilateral External Ear with Synthetic Substitute, External Approach

09R2XKZ Replacement of Bilateral External Ear with Nonautologous Tissue Substitute, External Approach

09U00JZ Supplement Right External Ear with Synthetic Substitute, Open Approach

09U00KZ Supplement Right External Ear with Nonautologous Tissue Substitute, Open Approach

09U0XJZ Supplement Right External Ear with Synthetic Substitute, External Approach

09U0XKZ Supplement Right External Ear with Nonautologous Tissue Substitute, External Approach

09U10JZ Supplement Left External Ear with Synthetic Substitute, Open Approach

09U10KZ Supplement Left External Ear with Nonautologous Tissue Substitute, Open Approach

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRV0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRVXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRVXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRW0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRW0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRWXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRWXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRX0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRX0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRXXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRXXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RN0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RN0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RNXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RNXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RP0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RP0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RPXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RPXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RQ0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RQ0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RQXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RQXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RR0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RR0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RRXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08RRXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08UN0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08UN0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08UNXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08UP0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08UPXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08UQ0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08UQXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08UR0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*08URXKZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*09R00JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*09R00KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*09R0XJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*09R0XKZ&_a=view









https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*09U00JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*09U00KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*09U0XJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*09U0XKZ&_a=view



14

09U1XJZ Supplement Left External Ear with Synthetic Substitute, External Approach

09U1XKZ Supplement Left External Ear with Nonautologous Tissue Substitute, External Approach

09U20JZ Supplement Bilateral External Ear with Synthetic Substitute, Open Approach

09U20KZ Supplement Bilateral External Ear with Nonautologous Tissue Substitute, Open Approach

09U2XJZ Supplement Bilateral External Ear with Synthetic Substitute, External Approach

09U2XKZ Supplement Bilateral External Ear with Nonautologous Tissue Substitute, External Approach

0HR0XJ3 Replacement of Scalp Skin with Synthetic Substitute, Full Thickness, External Approach

0HR0XJ4 Replacement of Scalp Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR0XJZ Replacement of Scalp Skin with Synthetic Substitute, External Approach

0HR1XJ3 Replacement of Face Skin with Synthetic Substitute, Full Thickness, External Approach

0HR1XJ4 Replacement of Face Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR1XJZ Replacement of Face Skin with Synthetic Substitute, External Approach

0HR2XJ3 Replacement of Right Ear Skin with Synthetic Substitute, Full Thickness, External Approach

0HR2XJ4 Replacement of Right Ear Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR2XJZ Replacement of Right Ear Skin with Synthetic Substitute, External Approach

0HR2XK3 Replacement of Right Ear Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HR2XK4 Replacement of Right Ear Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HR3XJ3 Replacement of Left Ear Skin with Synthetic Substitute, Full Thickness, External Approach

0HR3XJ4 Replacement of Left Ear Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR3XJZ Replacement of Left Ear Skin with Synthetic Substitute, External Approach

0HR3XK3 Replacement of Left Ear Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

0HR3XK4 Replacement of Left Ear Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

0HR4XJ3 Replacement of Neck Skin with Synthetic Substitute, Full Thickness, External Approach

0HR4XJ4 Replacement of Neck Skin with Synthetic Substitute, Partial Thickness, External Approach

0HR4XJZ Replacement of Neck Skin with Synthetic Substitute, External Approach

0HRAXJ3 Replacement of Genitalia Skin with Synthetic Substitute, Full Thickness, External Approach

0HRAXJ4 Replacement of Genitalia Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRAXJZ Replacement of Genitalia Skin with Synthetic Substitute, External Approach

0HRFXJ3 Replacement of Right Hand Skin with Synthetic Substitute, Full Thickness, External Approach

0HRFXJ4 Replacement of Right Hand Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRFXJZ Replacement of Right Hand Skin with Synthetic Substitute, External Approach

0HRGXJ3 Replacement of Left Hand Skin with Synthetic Substitute, Full Thickness, External Approach

0HRGXJ4 Replacement of Left Hand Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRGXJZ Replacement of Left Hand Skin with Synthetic Substitute, External Approach

0HRMXJ3 Replacement of Right Foot Skin with Synthetic Substitute, Full Thickness, External Approach

0HRMXJ4 Replacement of Right Foot Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRMXJZ Replacement of Right Foot Skin with Synthetic Substitute, External Approach

0HRNXJ3 Replacement of Left Foot Skin with Synthetic Substitute, Full Thickness, External Approach

0HRNXJ4 Replacement of Left Foot Skin with Synthetic Substitute, Partial Thickness, External Approach

0HRNXJZ Replacement of Left Foot Skin with Synthetic Substitute, External Approach

0WUM0JZ Supplement Male Perineum with Synthetic Substitute, Open Approach

0WUM0KZ Supplement Male Perineum with Nonautologous Tissue Substitute, Open Approach

0WUN0JZ Supplement Female Perineum with Synthetic Substitute, Open Approach

0WUN0KZ Supplement Female Perineum with Nonautologous Tissue Substitute, Open Approach

CPT #15277 Conversion to ICD-10 PCS 08RN0JZ Replacement of Right Upper Eyelid with Synthetic Substitute, Open Approach

08RN0KZ Replacement of Right Upper Eyelid with Nonautologous Tissue Substitute, Open Approach

08RNXJZ Replacement of Right Upper Eyelid with Synthetic Substitute, External Approach

08RNXKZ Replacement of Right Upper Eyelid with Nonautologous Tissue Substitute, External Approach

08RP0JZ Replacement of Left Upper Eyelid with Synthetic Substitute, Open Approach

08RP0KZ Replacement of Left Upper Eyelid with Nonautologous Tissue Substitute, Open Approach

08RPXJZ Replacement of Left Upper Eyelid with Synthetic Substitute, External Approach

08RPXKZ Replacement of Left Upper Eyelid with Nonautologous Tissue Substitute, External Approach

08RQ0JZ Replacement of Right Lower Eyelid with Synthetic Substitute, Open Approach

08RQ0KZ Replacement of Right Lower Eyelid with Nonautologous Tissue Substitute, Open Approach


























https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRAXJ3&_a=view


https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRAXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRFXJ3&_a=view


https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRFXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRGXJ3&_a=view


https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRGXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRMXJ3&_a=view


https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRMXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRNXJ3&_a=view


https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0HRNXJZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0WUM0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0WUM0KZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0WUN0JZ&_a=view

https://www.encoderpro.com/epro/i10pcsHandler.do?_k=202*0WUN0KZ&_a=view











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CPT #15277 Conversion to ICD-10 PCS

08RN0JZ Replacement of Right Upper Eyelid with Synthetic Substitute, Open Approach

08RN0KZ Replacement of Right Upper Eyelid with Nonautologous Tissue Substitute, Open Approach

08RNXJZ Replacement of Right Upper Eyelid with Synthetic Substitute, External Approach

08RNXKZ Replacement of Right Upper Eyelid with Nonautologous Tissue Substitute, External Approach

08RP0JZ Replacement of Left Upper Eyelid with Synthetic Substitute, Open Approach

08RP0KZ Replacement of Left Upper Eyelid with Nonautologous Tissue Substitute, Open Approach

08RPXJZ Replacement of Left Upper Eyelid with Synthetic Substitute, External Approach

08RPXKZ Replacement of Left Upper Eyelid with Nonautologous Tissue Substitute, External Approach

08RQ0JZ Replacement of Right Lower Eyelid with Synthetic Substitute, Open Approach

08RQ0KZ Replacement of Right Lower Eyelid with Nonautologous Tissue Substitute, Open Approach














































































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Documents

Reimbursement Guide - MLM Biologics · 2019-05-18 · Reimbursement Guide bio-ConneKt® Wound Matrix For the Treatment of ... CPT™ (Current Procedural Terminology) and ICD-10 PCS