Compression is an essential component of both healing and preventing venous leg ulcers. Not only do compression garments, such as the EXTREMIT-EASE® Compression Garment, help to treat difficult lower leg ulcers, they can also be stocked in your office and dispensed to patients as a DME item, providing your patients with excellent care and providing your office with profits.
Coding for Compression
For garments that provide 30-50 mmHg, the appropriate HCPCS code is A6545 (Gradient compression wrap, non-elastic, below knee, 30-50 mmHg, each). It is important that the diagnosis codes pointing to A6545 represent a lower extremity ulcer requiring compression. These include the I83- or I87- code listed first to identify the underlying condition followed by the L97- code to identify the severity of the ulcer.
Do Not Forget the Modifiers!
When billing for compression, the -A modifier referred to in last month’s blog should not be used. Instead, the A6545 code must have an -AW modifier appended to it (Item furnished in conjunction with a surgical dressing). The -AW modifier should only be used with codes for certain compression garments, including EXTREMIT-EASE, and tape codes A4450 and A4452.
In additional to the -AW modifier, a laterality modifier of either RT (for right leg) or LT (for left leg) should be appended to the A6545 code.
An example of proper coding when the EXTREMIT-EASE Compression Garment is dispensed would be:
- Diagnosis codes I83.222 (Varicose veins of lower-left extremity with both ulcer of calf and inflammation) followed by L97.221 (Non-pressure chronic ulcer of left calf limited to breakdown of skin),
- Pointing to A6545, with
- Both AW and LT modifiers appended
DISCLAIMER: The information provided here is intended to educate health care providers regarding compliance for diagnosis and CPT coding. The information provided does not guarantee reimbursement and is accurate to the best of our knowledge at the time of this publication. Coding guidelines can change and we encourage you to stay up to date. The existence of a code does not guarantee payment.
About the Author
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPCDr. Lehrman is in private practice in Fort Collins, CO and operates Lehrman Consulting, LLC. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. He is a Fellow of the American Academy of Podiatric Practice Management and an Expert Panelist on Codingline. In his role as a Consultant to the APMA Health Policy and Practice Department, Dr. Lehrman serves as an advisor to the APMA Coding Committee and the APMA MACRA Task Force. Dr. Lehrman sits on the board of directors of both the American Professional Wound Care Association and the American Society of Podiatric Surgeons. He is also on the editorial advisory board of the journal WOUNDS.