A: Hopefully, Apligraf Skin Graft is something you’re interested in. This has to do with the skin grafts, and now with modern technology, manmade skin grafts are being used very frequently. There has been a lot of expansion in that part of the CPT manual because of it. This is just one small little area of skin grafts, so rather than a skin graft coming from the patient to go in another part of their body or coming from even a pig graft or something like that, this is a manmade graft and this is just one of them. So, a student out there had asked, how do we code these?
Right on their own site www.Apligraf.com they had some information about their codes, so we copied and pasted it here and this is right from their website. They basically copied and pasted it from the CPT manual but gave us a little bit more information for the wound location, so just like Alicia was showing you with the excision codes and the destruction codes, location, location, location is going to be very key to selecting your codes.
What is Apligraf – Medical Coding for Apligraf Skin Graft – Video
I’m going to show you how it looks in the CPT manual and then come back up here. Here’s an example. I just copied and pasted it from my CPT manual, of these codes they start with 15271 and you can see in the guidelines that I’ve highlighted here it says, “The supply of skin substitute graft(s) should be reported separately,” and we see this a lot in CPT. You’ve got the product, the item, and then the service. Because this is a manmade skin substitute we need to have a separate code for the product.
These codes here are talking about the service of applying it. You’ll notice the first word it says “application.” Just like Alicia was showing you on hers, you can see I’ve underlined the location – trunk, arms, or legs – for this bubble 15271, and then below it is also for trunk, arms, or legs, but the difference is the size. This 271 is your first 25 square centimeters, and 272 is each additional 25 square centimeters.
Notice this language, they didn’t have this when I first started teaching coding, and it was very confusing. Now they put “or part thereof” and I was so thankful for that, so it’s letting you know if you have 30 square centimeters, you’ve got your 25 here, it’s allowing you to code that add-on code for that additional 5 because it says “each additional 25 sq cm wound surface area, or part thereof.” That’s very helpful.
Down here, we’ve got the same thing, application of skin substitute graft to trunk, arms and legs, total wound surface greater than or equal to 100 sq cm. The first thing you need to figure out is what’s the overall to get in the right bubble? If it’s less than 99, use the 271 bubble. If it’s greater than 100, use the 273 bubble. You’ve got first 100 sq cm, each additional 100 sq cm; again for trunk, arms, or legs.
Then the other location bubble has to do with the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits. I have no idea why they divided it this way, it’s just if the wound that you’re treating is in that area then you’re going to use these bubbles. It’s the same pattern 275 and 276, that bubble is if the square centimeters is less than 99, and the 15277 bubble is if it’s greater than 100 sq cm.
Basically, you have eight codes to choose from, but by doing this visual thing of bubbling and highlighting (BHAT™ method) it makes it a lot easier to find and choose your codes. That’s really all that they did up here is they just took them and they retyped them first 25 sq cm, each additional 25 sq cm for theleg, and then this is first 100 sq cm, each 100 for the leg. Because this Apligraf they tend to use more for diabetics and things like that so they focused more on the leg and the feet, even though the CPT codes cover other areas this particular manmade skin substitute tends to be used in this fashion.
Basically, that’s how these codes work and so you want to have another code for the product, the Apligraf itself, and you probably want to use a HCPCS code for that, so this is a good website to Google.
I want to show you, I always try and get this trick in each time. I wanted to go to this site www.Apligraf.com, so I’m going to grab this name and you can use this for anything not just coding. I’m going to type in my keyword. I wanted to know what they were recommending the CPT code was. I put “CPT site:apligraf.com” – the website you want to search. It’s doing a Google search but specifically of a keyword on a limited website. I’m going to hit enter. Now, I’ve got all this information, so rather than trying to search through their site and find it and it was a little hard to find, I just did it this way. We can see they have a PDF of Hospital Outpatient information on the code, Physician Office Rate Sheet, some information from Palmetto. It’s a really good way to be your own researcher and your own consultant to figure out questions that way.
Now if I put “Apligraf” as my keyword and now I did the site let’s do AAPC.com. I have no idea if there’s anything here, I’m just doing this. They didn’t find anything. That’s the way to see, is anyone talking about this on a particular website that you like? Hopefully, that’s a little trick that can help you.
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