When reporting diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity for a Medicare beneficiary in 2011, you’ll use two temporary G codes.
Providers were concerned about the different global periods for two tissue cultured skin substitutes codes causing financial incentive to use one product over another. “General surgeons, podiatrists, plastic surgeons, and wound care specialists were concerned that Apligraf had a 90 day global period versus Dermagraft, which had a 30 day global period,” explained Marc Hartstein, Deputy Director for the Hospital and Ambulatory Policy Group for the Center for Medicare in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT and RBRVS 2011 Annual Symposium in Chicago on Nov. 10, 2010.
Apligraf (which for 2010 is coded with 15430 or 15431) application involves up to 5 treatments over a 12-week period, where as Dermagraft (CPT 2010 codes 15360, 15361, 15365, and 15366) is applied weekly, up to 8 treatments over 1 12-week period.
During 2011, new codes will be worked on and valued. This will pave the way for CPT 2012 to offer Category III codes that will replace the 2011 G codes. The G codes will read:
- G0440 (Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less)
- G0441 ( … each additional 25 sq cm).
