Healthcare Industry News: Diabetic Foot Ulcer
News Release - April 12, 2006
New CPT and HCPCS J Codes Released from the American Medical Association and Centers for Medicare & Medicaid Services Relevant to OASIS(R) Wound Matrix and OASIS(R) Burn MatrixFORT WORTH, Texas, April 12 (HSMN NewsFeed) -- HEALTHPOINT announced that as of January 1, 2006 the American Medical Association has released two new Current Procedural Terminology (CPT)® Codes that are relevant to the application of OASIS products. In addition, the Centers for Medicare & Medicaid Services has introduced a new HCPCS Level II code relevant to OASIS products.
The new code descriptions are detailed below for reference by the clinical community: 15430 Acellular xenograft implant; first 100 sq cm or less, or one percent of body area of infants and children 15431 Acellular xenograft implant; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) HCPCS Level II Dermal (substitute) tissue of non-human origin, J7341 with or without other bioengineered or processed elements, with metabolically active elements, per square centimeterThe OASIS Wound Matrix is a bioresorbable, three-dimensional, cell-free matrix derived from porcine small intestinal submucosa. OASIS is indicated for the management of partial and full-thickness wounds, such as venous stasis ulcers and diabetic foot ulcers. Such wounds are often characterized as difficult to heal and may be at risk of becoming chronic. The OASIS Wound Matrix is designed to replace the missing or dysfunctional extracellular matrix -- a structural and functional complex that normally surrounds cells in human tissues -- thereby aiding in the management of these often debilitating wounds by providing an environment that supports the body's natural mechanisms.
Difficult to heal and chronic wounds -- typically caused by conditions such as diabetes(1), venous hypertension(2), and immobility-induced pressure on soft tissues(3) -- are associated with an economic burden estimated to be many billions of dollars annually in the U.S. alone.(4,5,6)
The OASIS Wound Matrix and OASIS Burn Matrix line of products are marketed and distributed exclusively by HEALTHPOINT, and manufactured by Cook Biotech.
Each year, in the United States, health care insurers process over 5 billion claims for payment. In order for all health insurance programs (including Medicare) to ensure that these claims are processed in an orderly and consistent manner, standard codes have been devised. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS.
Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a uniform coding system maintained by the American Medical Association (AMA). Health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. The CPT codes are republished and updated annually by the AMA.
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.
About Cook Biotech, Inc.
Cook Biotech Incorporated, located in West Lafayette, Indiana, was established in 1995 to research, develop and manufacture products based on extracelular matrix (ECM) Technology. Cook Biotech is actively developing ECM and scaffold-based biomaterials for numerous medical purposes. Medical products utilizing Cook's patented ECM Technology are currently marketed worldwide for use in wound management and surgical repair of soft tissue. Together with a network of medical practitioners, Cook Biotech is identifying the medical needs most compatible with ECM technology and developing products to meet these needs.
About HEALTHPOINT, Ltd.
Since its inception in 1992, HEALTHPOINT has established a presence in the research, development and marketing of branded pharmaceuticals, over the counter products, and medical devices for surgical, tissue management and dermatology indications. An aggressive research and development effort has brought HEALTHPOINT's unique technologies to the market, setting the pace for its highly trained field sales organization of direct sales representatives. HEALTHPOINT, with over 300 employees, is a DFB Pharmaceuticals, Inc. affiliate company. HEALTHPOINT is based in Fort Worth, Texas.
Also headquartered in Fort Worth, DFB Pharmaceuticals, Inc., provides technology-driven products, outsourcing services, and licensing opportunities to the healthcare industry worldwide through its affiliate companies, contract partners, and branded marketing organizations.
If you have any questions regarding these codes, call the Reimbursement Director at 1-800-533-5055 Access Code 08.
Information on reimbursement in the U.S. is provided as a service. Due to the rapidly changing nature of the law and our information provided by outside sources, the information provided herein does not constitute a guarantee or warranty by that reimbursement will be received. This information is provided "AS IS" and without any other warranty or guarantee, implied, as to completeness or accuracy, or otherwise. This information has been compiled based on data gathered from primary and secondary sources, including the American Medical Association, certain Medicare Carriers, and certain Medicare Intermediaries (FIs). Physicians and other providers must confirm or clarify coding and coverage from their respective payers, payer may have differing Local Coverage Determinations (LCDs). Physicians and providers are responsible for accurate documentation of patient conditions and for reporting of procedures and products in accordance with particular payer requirements.
(1) Pham HT, Economides PA, Veves A. The role of endothelial function on the foot. Microcirculation and wound healing in patients with diabetes. Clin Podiatr Med Surg. 1998;15(1):85-93.
(2) Guillot B, Dandurand M, Guilhou JJ. Skin perfusion pressure in leg ulcers assessed by photoplethysmography. Int Angiol. 1988 Apr-Jun;7(2 Suppl):33-4.
(3) Schubert V, Perbeck L, Schubert PA. Skin microcirculatory and thermal changes in elderly subjects with early stage of pressure sores. Clin Physiol. 1994;14(1):1-13.
(4) Olin JW, Beusterien KM, Childs MB, Seavey C, McHugh L, Griffiths RI. Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study. Vasc Med. 1999;4(1):1-7.
(5) Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care. 2003;26(6):1790-1795.
(6) Bergstrom N, Bennett MA, Carlson, et al. Treatment of pressure ulcers. Clinical practice guideline, no. 15. Rockville (MD): US Department of Health and Human Services. Public Health Service. Agency for Health Care Policy and Research. AHCPR Publication No. 95-0652, 1994 Dec. Available at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.section.5360. Accessed February 28, 2006.
(7) Centers for Medicare and Medicaid Services, Department of Health and Human Services. HCPCS General Information; Background Information. http://www.cms.hhs.gov/MedHCPCSGenInfo/
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