How To Use HCPCS Code C5277

HCPCS code C5277 describes the application of a low-cost skin substitute graft to various areas of the body, including the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and multiple digits. This code is used when the total wound surface area is greater than or equal to 100 square centimeters, or when the wound surface area is the first 100 square centimeters or 1% of the body area of infants and children.

1. What is HCPCS C5277?

HCPCS code C5277 is used to identify the application of a low-cost skin substitute graft to specific areas of the body. This code is used when the wound surface area is significant and requires the use of a skin substitute graft for proper healing. It is important to note that this code specifically refers to low-cost skin substitute grafts.

2. Official Description

The official description of HCPCS code C5277 is “Application of low-cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children.” The short description is “Enteral supp not otherwise c.”

3. Procedure

1. The provider begins by assessing the wound and determining the total wound surface area.
2. If the wound surface area is greater than or equal to 100 square centimeters, or if it is the first 100 square centimeters or 1% of the body area of infants and children, the provider proceeds with the application of a low-cost skin substitute graft.
3. The provider prepares the skin substitute graft according to the manufacturer’s instructions.
4. The provider cleans and prepares the wound bed, removing any necrotic tissue or debris.
5. The provider applies the skin substitute graft to the wound, ensuring proper coverage and adherence.
6. The provider dresses the wound with appropriate dressings to protect the graft and promote healing.
7. Follow-up care and monitoring of the wound are essential to ensure proper healing.

4. When to use HCPCS code C5277

HCPCS code C5277 should be used when the wound surface area meets the criteria specified in the official description. It is important to accurately assess and document the wound surface area to ensure proper coding and billing. This code is specifically for the application of low-cost skin substitute grafts to the specified areas of the body.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C5277, healthcare providers need to document the wound surface area, the specific areas of the body where the graft was applied, and any relevant details regarding the procedure. It is important to include supporting documentation, such as photographs or measurements, to substantiate the use of this code. Proper documentation is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C5277 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.

7. Medicare and Insurance Coverage

HCPCS code C5277 is covered by Medicare. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. It is important to check with individual insurance providers to determine coverage and reimbursement rates for this code.

8. Examples

Here are five examples of when HCPCS code C5277 should be billed:

1. A patient has a large wound on their scalp with a surface area of 120 square centimeters. The provider applies a low-cost skin substitute graft to the wound.
2. An infant has a wound on their hand that covers 2% of their body area. The provider applies a low-cost skin substitute graft to the wound.
3. A patient has multiple wounds on their face, totaling 150 square centimeters in surface area. The provider applies a low-cost skin substitute graft to the wounds.
4. A child has a wound on their genitalia that covers 1% of their body area. The provider applies a low-cost skin substitute graft to the wound.
5. A patient has a wound on their foot with a surface area of 80 square centimeters. Since the wound surface area does not meet the criteria for this code, HCPCS code C5277 would not be billed.