Downloaded from http://journals.lww.com/dermatologicsurgery by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60EtgtdlLYrLzSPu+hUapVK5dvms8 on 11/01/2020 EDITORIAL A Call to Action: Using Current Procedural Terminology Category III Codes for Laser Fenestration of Burn and Traumatic Scars for Functional Improvement Functional Limitation Caused by Traumatic and Burn Scars Traumatic and burn scars can result in severe physical and psychological consequences such as life-altering disfigurement, functional restriction, and overall decreased quality of life. Disfiguring scars are asso- ciated with anxiety and depressed mood. 1,2 The incidence of hypertrophic scars 2 years after trau- matic burn is up to 80.1%. 3 Traumatic scarring across joints can reduce range of motion, limiting activities of daily living, with contractures and skin tightening involving the hand in 48.5% of burns and mouth in 13.7%, as reported in the Burn Model System National Database. 3 Given these con- sequences, the use of energy-based devices to treat functionally limiting scars is a pivotal medical advancement. Issues in Using Current Procedural Terminology Code in Laser Fenestration of Scars for Functional Improvement Laser fenestration can be an effective, minimally invasive treatment for traumatic scars. Ablative fractional CO 2 laser therapy can reduce the depth of scars, decrease production of type I collagen within, and relieve functional impairments. 4–6 Despite this demonstrated effectiveness, reim- bursement has been a persistent challenge, with no current Category I Current Procedural Terminol- ogy (CPT) code for laser treatment of scars. Fur- thermore, there is a lack of consensus among payors that the management of scars with lasers is necessary. Physicians have reported using codes 17999 (unlisted procedure, skin, mucous mem- brane, and subcutaneous tissue) and 17110 (removal of benign lesions other than skin tags or cutaneous vascular lesions), but payors have inconsistently reimbursed laser scar fenestration under these. 7 Some physicians seek insurance pre- approval, including sending peer-reviewed litera- ture with patient photos. 7 Regardless, reimburse- ment is not guaranteed. On the other hand, there is a consensus among physicians that laser fenes- tration of scars causing functional impairment is a well-established, highly effective, and medically necessary procedure that should be fully reim- bursed. Recently, Category III CPT test codes for laser fenestration of traumatic scars have been created 0479T and +0480T. 8 Why Use Current Procedural Terminology Category III Codes for Laser Fenestration of Traumatic and Burn Scars? Current Procedural Terminology codes are created and maintained by the CPT Editorial Panel under the purview of the American Medical Association. Category I CPT codes are designated for procedures widely used across the country. 9 Category III codes are emerging technology codes that describe novel procedural or investigational procedures that have not been widely accepted. 10 Five years after Class III codes are introduced, they sunset, unless they are renewed as Category III codes or elevated to Cate- gory I based on criteria including FDA approval, proven effectiveness as evidenced in high-quality peer-reviewed literature, and widespread use by many practitioners in many geographic areas (Fig- ure 1). If a Category III code is changed to a Cate- gory I code, the Relative Value Scale Update Committee (RUC) assigns the code a value in “rel- ative value units,” (RVUs) a measure that allows for comparison of the physician work and practice expense across disparate medical services. After the RUC determines a procedure’s RVUs, the Centers for Medicare and Medicaid Services accepts or © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 1076-0512 · Dermatol Surg 2020;46:1430–1432 · DOI: 10.1097/DSS.0000000000002586 1430 © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.