By Margie Scalley Vaught
New HCFA Common Procedure Coding System (HCPCS) codes that can affect the billing for federally funded programs have been added for use in 2000.
HCPCS codes G0168-G0171, published in the Nov. 2, 1999 Federal Register by the Health Care Financing Administration (HCFA), went into effect on Jan 1, 2000. Code G0168 is for "wound closure utilizing tissue adhesives only." This HCPCS code should be used if a wound is closed solely with the use of tissue adhesives. The rationale for this code and its RVU assignment is based on U.S. Food and Drug Administration data that show wounds closed with tissue adhesives is, on average, one-quarter of the time needed to close a wound with traditional method of treatment, including use of wound closure tapes. HCFA said in the Federal Register notice, "We estimate that the work of HCPCS code G0168 is comparable to the work of a level two E/M service and have assigned a work RVU of .45."
HCFA also presented code G0169"removal of devitalized tissue, without the use of anesthesia (conscious sedation, local, regional or general)." In the Nov. 2 Federal Register, HCFA states, "This code was created because the CPT codes 11040 through 11044 for debridement were created to describe complex surgical services requiring the use of general anesthesia. Many practitioners, including physical therapists, occupational therapists and nurses, do active wound care under physicians orders. Active care involves the use of high pressure water jets, scissors or scalpels The service to be coded with HCPCS code G0169 typically involves regular removal of devitalized tissues in ulcers or non-healing wounds."
It was believed that this code was needed to eliminate the confusion when using debridement codes, which may have a 10-day global period. G0169 would be recognized for the purpose of physical and occupational therapy service involved in this sort of debridement. It is interesting to note that the work value assigned to this code is 0.5, which is similar to code 11040.
Codes G0170 and G0171 are for "application of tissue cultured skin grafts, including bilaminate skin substitutes or neodermis, including site preparation, initial 25 sq cm; and each additional 25 sq cm." In 1999, we were instructed to use CPT codes 15100 to 15121 to report these procedures. However, HCPCS codes G0170 and G0171 should be used for Medicare claims in 2000. The Nov. 2 Federal Register says, "The CPT codes for split-thickness skin grafts may no longer be used to describe tissue cultured or bilaminate skin substitutes or neodermis. Because the tissue cultured and bioengineered products are available for use on small skin ulcers... we estimate that the physician work in using these cultures and bioengineered products is considerably less than the work in performing split-thickness skin grafts."
For complete details regarding these HCPCS codes, please refer to the Nov. 2, 1999 Federal Register, starting on page 59427.
The rule on tissue adhesive closure of wounds only relates to Medicare and other government insurance. The Federal Register notice states that the use of a combination of tissue and other traditional types of wound closure should be coded using CPT codes 12001-12007.
Margie Scalley Vaught, CPC, is an independent coding specialist in Ellensburg, Wash. She also is a member of the American Academy of Professional Coders National Advisory Board.
What is the "rule of thumb" for the following situation? Doctor 1 performs an Admission History and Physical and a surgical procedure on Feb. 2, 2000. Doctor 2 (from same practice) wants to charge for a Hospital Visit on the same patient on Feb. 3, 2000, which is the same date of discharge. Can Doctor 2 charge for the hospital visit or is that considered under the global concept?
Since Dr. 1 and Dr. 3 are in the same group practice (same tax identification number), Dr. 3 can not charge for a hospital visit postoperatively unless it is for an unrelated diagnoses. You did not state if Dr. 1 and Dr. 3 are in the same specialty or if Dr. 3 was seeing the patient for an unrelated diagnosis. If Dr. 3 is just covering for Dr. 1 and discharging the patient for him, he can not charge for this during the global period. Rule of thumb is that patients being seen in a group practice (same specialty) during a global period should not be charged for routine follow-up related to the operative procedure (same diagnoses). The only time that you can charge a patient during the global period is for complications and/or unrelated diagnoses. This information can be found in the AAOS Complete Global Service Data book in addition to the Medicare Carriers Manual and the CPT manual under "Global Service".