 |
| INTEGRA™ Bilayer
Matrix Wound Dressing Reimbursement |
|
Below is information regarding appropriate codes to utilize
for reimbursement of INTEGRA™
Bilayer Matrix Wound Dressing when it is applied
in either the inpatient or outpatient setting. If you have
additional reimbursement questions, please call 1-877-444-1122
and choose option 3 for our reimbursement hotline or contact
your local Plastic and Reconstructive Sales Specialist.
Facility
Reimbursement - Inpatient
ICD-9
Code |
Code
Description
|
2008 Potential
DRG's
|
|
86.67
|
Dermal Regenerative Graft
|
463-465, 573-578,
622-624, 904-906
|
Applicable DRG Assignments Associated
with Code 86.67 For INTEGRA™ Bilayer Matrix Wound Dressing
|
MS-DRG
|
Description
|
Relative
Weight (RV)
|
GMLOS
Geometric Mean Length of
Stay
|
AMLOS
Arithmetic Mean Length of
Stay
|
|
463
|
Wound Debridement and
Skin Graft Except Hand, for Musculoskeletal and Connective
Tissue Disorders with MCC |
3.9615
|
12.3
|
16.9
|
|
464
|
Wound Debridement
and Skin Graft Except Hand, for Musculoskeletal
and Connective Tissue Disorders with CC
|
2.8821
|
7.8
|
10.4
|
|
465
|
Wound Debridement
and Skin Graft Except Hand, for Musculoskeletal
and Connective Tissue Disorders w/o MCC/CC
|
2.3417
|
4.6
|
6.2
|
| 573 |
Skin Graft and/or Debridement
for Skin Ulcer or Cellulitis with MCC |
2.7483 |
10.1 |
13.8 |
| 574 |
Skin Graft and/or Debridement
for Skin Ulcer or Cellulitis with CC |
2.0177 |
7.2 |
9.5 |
|
575
|
Skin Graft and/or
Debridement for Skin Ulcer or Cellulitis w/o MCC/CC
|
1.4216
|
4.7
|
5.9
|
|
576
|
Skin Graft and/or Debridement
Except for Skin Ulcer or Cellulitis with MCC |
2.4766
|
7.8
|
12.1
|
|
577
|
Skin Graft and/or Debridement
Except for Skin Ulcer or Cellulitis with CC |
1.6262
|
4.1
|
6.0
|
|
578
|
Skin Graft and/or Debridement
Except Skin Ulcer or Cellulitis w/o MCC/CC |
1.0742
|
2.5
|
3.4
|
|
622
|
Skin Graft and Wound
Debridement for Endocrine, Nutritional, and Metabolic
disorders with MCC |
2.7257
|
9.7
|
13.2
|
|
623
|
Skin Graft and Wound
Debridement for Endocrine, Nutritional, and Metabolic
disorders with CC |
2.0065
|
6.8
|
8.7
|
|
624
|
Skin Graft and Wound
Debridement for Endocrine, Nutritional, and Metabolic
disorders with/out MCC/CC |
1.6056
|
4.6
|
5.9
|
|
904
|
Skin Graft for injuries
with MCC/CC |
2.5246
|
7.2
|
12.2
|
|
905
|
Skin Graft for injuries
with/out MCC/CC |
1.5926
|
3.5
|
4.7
|
|
906
|
Hand Procedures for Injuries |
0.9803
|
2.2
|
3.3
|
*The American Hospital Association's Central Office on
ICD-9-CM has advised Integra LifeSciences that the appropriate
ICD-9 procedure code when using the INTEGRA™ Bilayer
Matrix Wound Dressing is code 86.67, Dermal Regenerative
Graft, for the procedure performed.
**The information being provided is for reference only.
Providers of service assume total responsibility for
correct reimbursement filing, billing and coding. Use
of this code in no way guarantees payment.
Facility
Reimbursement - Outpatient
|
CPT
Code
|
Code
Description
Based on Size of Wound
|
APC CODE
|
|
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% body area
of infants and children |
135
|
|
15003
|
Each additional 100 sq
cm or each additional 1% of body area of infants
and children (List separately in addition to code
for primary procedure) |
135
|
|
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% body area of infants and children |
135
|
|
15005
|
Each additional 100 sq cm or each
additional 1% of body area of infants and children
(List separately in addition to code for primary
procedure) |
135
|
|
15170
|
Acellular graft- trunk,
arms, legs- first 100 sq cm or less |
134
|
|
15171
|
Each additional 100 sq
cm |
134
|
|
15175
|
Acellular graft- face, scalp, eyelids,
mouth, neck, ears, orbits, genitalia, hands, feet,
and/or multiple digits-first 100 sq cm or less |
135
|
|
15176
|
Each additional 100 sq
cm |
135
|
|
15110
|
Epidermal Autograft- trunk,
arms, legs- first 100 sq cm or less |
135
|
|
15111
|
Each additional 100 sq
cm |
135
|
|
15115
|
Epidermal Autograft- face, scalp,
eyelids, mouth, neck, ears, orbits, genitalia, hands,
feet, and/or multiple digits- first 100 sq cm or
less |
135
|
|
15116
|
Each additional 100 sq
cm |
135
|
NOTE: Use Modifier -58
for staged procedure as applicable.
Physician
Reimbursement
|
CPT
Code
|
Code
Description
Based on Size of Wound
|
Relative Work
Value
|
|
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% body
area of infants and children |
3.65
|
|
15003
|
Each additional 100 sq
cm or each additional 1% of body area of infants
and children (List separately in addition to code
for primary procedure) |
0.8
|
|
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% body area of infants and children |
4.58
|
|
15005
|
Each additional 100 sq cm or each
additional 1% of body area of infants and children
(List separately in addition to code for primary
procedure) |
1.6
|
|
15170
|
Acellular graft- trunk,
arms, legs- first 100 sq cm or less |
5.99
|
|
15171
|
Each additional 100 sq
cm |
1.55
|
|
15175
|
Acellular graft- face, scalp, eyelids,
mouth, neck, ears, orbits, genitalia, hands, feet,
and/or multiple digits-first 100 sq cm or less |
7.99
|
|
15176
|
Each additional 100 sq
cm |
2.45
|
|
15110
|
Epidermal Autograft- trunk,
arms, legs- first 100 sq cm or less |
10.88
|
|
15111
|
Each additional 100 sq
cm |
1.85
|
|
15115
|
Epidermal Autograft- face, scalp,
eyelids, mouth, neck, ears, orbits, genitalia,
hands, feet, and/or multiple digits- first 100
sq cm or less |
11.19
|
|
15116
|
Each additional 100 sq
cm |
2.5
|
|
HCPCS Code
|
Code
Description
|
|
J7343 - Integra Bilayer
Matrix Wound Dressing
|
Dermal and Epidermal
Tissue of Non-Human Origin, with or without other
bioengineered or processed elements, without metabolically
active elements, per square centimeter (reimbursement
rate is updated quarterly) |
***Utilize all appropriate modifiers.
***THE INFORMATION BEING PROVIDED IS FOR REFERENCE
ONLY. PROVIDERS OF SERVICE ASSUME TOTAL RESPONSIBILITY
FOR CORRECT REIMBURSEMENT FILING, BILLING, AND CODING.
USE OF THESE CODES DOES NOT GUARANTEE PAYMENT.
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All Rights Reserved.
DISCLAIMER
Integra LifeSciences Corporation has taken
every effort to ensure that the information presented
on this web page is correct. Due to ongoing changes in
government and insurance industry rules and regulations
and the constant flow of information on reimbursement,
Integra LifeSciences Corporation assumes no responsibility
for any results obtained by any individual, agency, facility,
or business for using the information contained here.
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