G0440, G0441: Level the Skin Substitute Playing Field With These Codes

Tue, May 17, 2011 --

Coding Updates

Stop 15340, 15360 ‘global days’ prejudice.

This year, when your surgeon applies a tissue-cultured skin or dermal substitute for Medicare patients with lower extremity ulcers due to venous statis or diabetes, you have two temporary ‘G’ codes at your disposal.

Move from CPT to HCPCS for Medicare

Whether Apligraf or Dermagraft, you should report G0440 and G0441 to report your surgeon’s work this year. That is a change from using existing CPT codes for the service, which depend on the type of skin or dermal substitute as follows:

  • Apligraf — 15340-+15341 (Tissue cultured allogeneic skin substitute …)
  • Dermagraft — 15360-+15361 (Tissue cultured allogeneic dermal substitute, trunk, arms, legs …) or 15365-+15366 (Tissue cultured allogeneic dermal substitute, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits …)

You should keep on using the 15300-series codes for most non-Medicare payers

Lose the Brand Incentive

Even though your surgeon may prefer one skin or dermal substitute product or the other for clinical reasons in particular cases, coverage quirks for the CPT codes can provide payment loopholes that sway product choice.

Problem: Marc Hartstein, deputy director for the Center for Medicare Hospital and Ambulatory Policy Group in his presentation with Kenneth Simon, senior medical officer for Center for Medicare, presented during the CPT and RBRVS 2011 Annual Symposium stated, “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.” This lead providers to use one product over another to gain financial advantage.

What’s more, 15340-+15341 include site preparation and debridement, while you can bill those services separately with 15360-+15366.

Answer: Used for either Apligraf or Dermagraft, codes G0440-G0441 have 0 global days and cover the site preparation and debridement services. States Geoff MacKay, CEO of Organogenesis in a press release, ““The new codes, together with a 0-day global billing period, will eliminate unequal financial incentives in the selection of products forthe treatment of chronic wounds as well as help ensure that physicians make their treatment decisions based solely on clinical benefit.”

Look ahead: CMS will work on valuing G0440 and G0441 this year to pave the way for CPT 2012 to offer category III codes to replace the temporary G codes.

About 

Barnali Gogoi is a medical coding and billing writer with over 7 years of experience in the industry. She holds a Masters Degree in English Literature from Gauhati University and a diploma in advertising and marketing from YMCA.

3 Comments For This Post

  1. Faith Says:

    Do you know where I can get information on Medicare’s website that states that we have to use the G codes? I have called Medicare and they state that both codes are valid and can not tell me where to go to get any information on this. There are not any LCD’s or articles for Georgia.

    Thank you

  2. barnalig Says:

    Hi Faith, you may take a look at the following sites to get information specific to your state – Georgia.

    http://www.cms.gov
    http://www.georgiamedicare.us
    https://www.cahabagba.com/
    http://georgiamedicareplans.net/
    http://www.medicare.org/home-mainmenu-1/travel-mainmenu-32/57-georgia/114-georgia-medicare.html

    Hope this helps. Thanks

  3. barnalig Says:

    There is another document that can help to understand usage policies for these 2 codes – G0440, G0441.

    http://www.apligraf.com/professional/pdf/Cahaba.pdf

    However, both the codes are valid. There’s no LCD for these 2 codes in state Georgia.

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