How To Use HCPCS Code C5274

HCPCS code C5274 describes the application of a low-cost skin substitute graft to the trunk, arms, legs, or any wound surface area greater than or equal to 100 sq cm. This code is used to identify the additional wound surface area or body area of infants and children that requires treatment with a skin substitute graft. It is important for medical coders to understand the specific meaning and usage of this code to ensure accurate billing and reimbursement.

1. What is HCPCS C5274?

HCPCS code C5274 is a specific code used in medical coding to identify the application of a low-cost skin substitute graft to the trunk, arms, legs, or any wound surface area greater than or equal to 100 sq cm. This code is used to indicate the additional wound surface area or body area of infants and children that requires treatment with a skin substitute graft. It is important to note that this code should be listed separately in addition to the primary procedure code.

2. Official Description

The official description of HCPCS code C5274 is “Application of low-cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure).” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. The provider begins by assessing the wound surface area or body area of infants and children that requires treatment with a skin substitute graft.
2. If the total wound surface area is greater than or equal to 100 sq cm, the provider applies a low-cost skin substitute graft to the trunk, arms, legs, or the specific area in need of treatment.
3. If there are additional wound surface areas of 100 sq cm or part thereof, or additional 1% of body area of infants and children or part thereof, the provider lists them separately in addition to the primary procedure code.
4. The application of the low-cost skin substitute graft is performed using appropriate medical techniques and materials.
5. The provider ensures proper documentation of the procedure, including the wound surface area, the location of the graft application, and any additional wound surface areas or body areas treated.

4. When to use HCPCS code C5274

HCPCS code C5274 should be used when the provider is applying a low-cost skin substitute graft to the trunk, arms, legs, or any wound surface area greater than or equal to 100 sq cm. This code is specifically used to identify the additional wound surface area or body area of infants and children that requires treatment with a skin substitute graft. It is important to list this code separately in addition to the primary procedure code to ensure accurate billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C5274, healthcare providers need to ensure proper documentation of the procedure. This includes documenting the wound surface area, the location of the graft application, and any additional wound surface areas or body areas treated. It is important to accurately calculate the additional wound surface areas or body areas to list them separately in addition to the primary procedure code. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C5274 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code is priced by other carriers, as indicated by the pricing indicator code 57. The multiple pricing indicator code A indicates that it is not applicable as HCPCS priced under one methodology. The Medicare Carriers Manual Reference Section Number for this code is 2130, 4450.

7. Medicare and Insurance Coverage

HCPCS code C5274 is subject to special coverage instructions, as indicated by the coverage code D. Medicare and other insurance providers may have specific guidelines and policies regarding the coverage and reimbursement for this code. It is important for healthcare providers to review the applicable coverage policies and guidelines to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code C5274 should be billed:

1. A 7-year-old child with a wound surface area of 150 sq cm on the leg requires the application of a low-cost skin substitute graft. HCPCS code C5274 should be used to identify the additional wound surface area.
2. An infant with multiple wounds on the trunk and arms has a total wound surface area of 250 sq cm. The provider applies a low-cost skin substitute graft to the trunk and arms. HCPCS code C5274 should be used to identify the additional wound surface area.
3. A 5-year-old child has a wound surface area of 120 sq cm on the leg and an additional wound surface area of 80 sq cm on the arm. The provider applies a low-cost skin substitute graft to both areas. HCPCS code C5274 should be used to identify the additional wound surface areas.
4. A 3-year-old child has a wound surface area of 90 sq cm on the trunk and an additional wound surface area of 50 sq cm on the leg. The provider applies a low-cost skin substitute graft to both areas. HCPCS code C5274 should be used to identify the additional wound surface areas.
5. A 6-year-old child has a wound surface area of 200 sq cm on the leg and an additional wound surface area of 150 sq cm on the arm. The provider applies a low-cost skin substitute graft to both areas. HCPCS code C5274 should be used to identify the additional wound surface areas.