I got an email today asking about 'Preparation and Preservation of Skin Graft'.  Since this code made it into the UHMS' approved indications list, this code has been a sticky-wicket.  For at least the past decade, Medicare has determined that the ICD-9-CM code 996.52 is the most appropriate code to represent the concept of ‘Preparation and preservation of compromised skin grafts’.  The actual definition for the code is ‘Mechanical complication of prosthetic graft of other tissue not elsewhere classified’.

Here is the specific text from the Local Coverage Determination for Hyperbaric Oxygen Therapy from Trailblazer’s (Texas MAC) website:

•  Preparation and preservation of compromised skin grafts (ICD-9-CM diagnosis code 996.52; excludes artificial skin):

HBO is utilized for graft or flap salvage in cases where hypoxia or decreased perfusion has compromised viability of an existing skin graft. HBO enhances flap survival. Treatments are given at a pressure of 2.0 to 2.5 atm lasting from 90–120 minutes. It is not unusual to receive treatments twice a day. When the graft or flap appears stable, treatments are reduced to daily. Medicare coverage does not apply to the initial preparation of the body site for a graft. HBO therapy is not necessary for normal, uncompromised skin grafts or flaps or for primary management of wounds.

For your convenience, I’ve attached a PDF copy of the current policy.

So, while our clinicians will correctly refer to the situation of preservation of a compromised skin graft, Medicare still refers to it as mechanical complication of graft.   Your facility's coding is done by professional coders reading your documentation, probably using a computerized tool to help them find the code, and then selecting your code from the ICD-9-CM system.  If they do not select 996.52, then Medicare will deny your claim.  So, if you don’t refer to the skin graft in terms that translate into 996.52, you are at a risk of having the coder select a different code.  I am not advocating coding for payment, I am explaining reality.  Let me repeat that.  If your coders do not select 996.52 for the diagnosis to reflect the preservation of a compromised skin graft, Medicare WILL DENY THE CODE.  It's all about a computer matching CPT to ICD-9 codes.  You may win on appeal, but probably only after someone has appropriately refined the claim to reflect the code 996.52.

Now, to better understand the issue, let's talk about ICD-9 usage. To find 996.52 in the alphabetic index, which is what your coder is trained to do, you have to go down a road of failure > transplant > skin.  Difficult to do when you start with ‘preservation of skin graft’.  So, to facilitate this process, at Intellicure we have had a long standing policy of referring to the issue in the same terms that Medicare uses; Mechanical complication of graft.  It absolutely sucks that this is a NEC (not elsewhere classified) code, but those are the cards we’ve been dealt.