Liz Burson, BS, CCS • September 5, 2025

Kerecis Intact Fish Skin Grafts: Documentation and Coding Considerations


Overview of Kerecis Intact Fish Skin Grafts

Kerecis, is the company pioneering the use of sustainably sourced fish skin in cellular therapy and tissue regeneration. In total, nearly 200 million people in the United States are now covered under commercial insurance plans that recognize fish skin grafts as medically necessary for chronic wound care. 


Clinical Use of Fish Skin Grafts in Tissue Regeneration

According to the Kerecis website, this graft “promotes healing with minimal impairment of functionality and positive cosmetic outcomes. The product is homologous to human skin and when applied to damaged tissue such as burns or wounds, helps top support the body’s own cells to regenerate tissue.” 


Coding Clinic has released official guidance regarding Kerecis graft application in the fourth quarter of 2024. Their guidance tells us to report this application as replacement of skin with nonautologous tissue, full thickness, external approach.  ( ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2024 Page: 65) 


CMS Coverage and Diagnosis Reporting Requirements

CMS has released an LCD regarding the covered diagnosis for this unique skin regeneration. This procedure requires a dual diagnosis requirement. When reporting E08.621, E09.621, E10.621, E11.621, E13.621, one of the following must be reported   with it to identify the site and severity of the ulcer: L97.411, L97.412, L97.415, L97.416, L97.421, L97.422, L97.511, L97.512, L97.515, L97.516, L97.521, L97.522, L97.525, or L97.526.




Liz Burson, BS, CCS 

Senior Consultant, Audit at UASI


Liz Burson serves as a Senior Consultant in Auditing at UASI, with 20+ years of outpatient and inpatient coding experience.  She provides coding tips based on current audit findings to help coders improve their accuracy in capturing the correct ICD-10-CM and PCS codes.   


Works Cited:

American Hospital Association. (2024). ICD-10-CM/PCS Coding Clinic, Fourth Quarter, 65.


Centers for Medicare & Medicaid Services. (n.d.). Local Coverage Determination (LCD): Skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers (L36377).
Available at https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=36377


Centers for Medicare & Medicaid Services. (n.d.). Billing and coding: Skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers (A57680).
Available at https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57680


Kerecis. (n.d.). Intact fish skin for tissue regeneration.
Available at https://www.kerecis.com

 

Title graphic with brain, When to Query for Hepatic Encephalopathy

When to Query for Hepatic Encephalopathy

By Alyce Reavis, RN, MSN, CCDS, CCS • July 7, 2026
Learn how hepatic encephalopathy ICD-10 coding works, what clinical indicators trigger a CDI query, and documentation requirements for accurate code capture.
Mother carrying newborn baby

Postpartum Hemorrhage: Documentation and Coding Considerations

By Alyce Reavis, RN,MSN,CCDS,CCS • June 23, 2026
Review clinical indicators, ICD-10-CM coding, CDI considerations, and query opportunities for postpartum hemorrhage documentation.
doctors hovering over operating table

Non-Infectious SIRS: Documentation and Coding Considerations

By Alyce Reavis, RN,MSN,CCDS,CCS • April 16, 2026
Review clinical indicators, coding rules, and documentation considerations for non-infectious SIRS, including R65.10 vs R65.11 and query guidance.
Graphic title, person sitting down and holding both hands to chest

When to Query for Acute Respiratory Failure with Hypoxia (J96.01)

By Alyce Reavis, RN,MSN,CCDS,CCS • April 15, 2026
Learn when to code acute respiratory failure with hypoxia (J96.01), including clinical indicators, documentation tips, and CDI query opportunities.
Graphic image for ICD-10-PCS Changes for April 1, FY 2026, doctor pointing to computer

ICD-10-CM and ICD-10-PCS Changes for April 1, FY 2026

By Alyce Reavis, RN,MSN,CCDS,CCS • March 16, 2026
Review key ICD-10-CM updates effective April 1, 2026 including Parkinson’s disease indexing changes, respiratory failure coding revisions, and neuroendocrine tumor classification updates.
Child with cerebral palsy smiling during therapy activity with motor impairment and supportive care.

Cerebral Palsy: Documenting Motor Type, Severity, and Coding Impact

By Alyce Reavis, RN, MSN, CCDS, CCS • January 26, 2026
Support accurate cerebral palsy ICD-10-CM coding with CDI guidance on clinical indicators, documentation requirements, and physician query opportunities.
CDI Tip Title Graphic, mom and baby sleeping text reads

Apnea of Prematurity CDI Tip

By Alyce Reavis, RN,MSN,CCDS,CCS • January 13, 2026
Clarify apnea of prematurity clinical indicators, treatment considerations, and CDI coding guidance to support accurate neonatal documentation and query decisions.
MRI brain scans illustrating symptoms of PRES with title text overlay.

Symptoms of PRES: Diagnosis, Treatment, and ICD-10-CM Coding Guidance

December 9, 2025
Learn the symptoms of PRES, key treatment considerations, ICD-10-CM code I67.83, and documentation tips for CDI and accurate DRG assignment.
Microscopic immune cells interacting in cellular environment, illustrating immune effector activity

CDI Tip: ICANS Grading and Accurate Documentation

By Alyce Reavis, RN, MSN, CCDS, CCS • December 1, 2025
Understand ICANS documentation and ICD-10 coding with guidance on the ICANS grading system, ICE score, clinical indicators, and CAR T-cell neurotoxicity.
Fingerstick blood glucose test being performed, illustrating screening and monitoring practices for gestational diabetes.

Gestational Diabetes

By Alyce Reavis, RN, MSN, CCDS, CCS • November 3, 2025
Define gestational diabetes documentation requirements, key risk factors, and clinical details needed to support accurate ICD-10 coding, severity capture, and quality reporting.
Show More