wound care question

[Anna Weaver]

Okay, here's the scenario, I don't have a particular OP report, but it goes like this:

Patient has a 5 cm ulceration on the abdomen. It heals in the middle and becomes 2 small ulcerations each 2 cm. Is this then considered one wound since it's contiguous? Or is it considered two wounds since there is a healing in the middle? We need to know because of debridements. Are they going to be charged one debridement to the deepest level, or is it going to be two debridements one for each wound? I'm leaning towards one debridement since it's just opposite ends of the same wound, BUT, right now (until we can find documentation) we are charging two. We can't find anything either way, so we're basically coders choice at this point. Any help appreciated, and all comments and commentaries welcome! Please give me your opinions or any documentation you might have. Thanks!!!

Anna

[LLovett]

What code set are you using?

I am no wound care expert by any means, but when my providers are doing debridement it is generally 97597 or 97598. In which case it doesn't matter how many wounds you have you just add up the total area.

If you are using 11040-11044, again size or number not an issue, just thickness.

I'm probably no help at all since the above are the only ones I have any personal experience with.

Laura, CPC

[Anna Weaver]

Originally Posted by katmryn78

What code set are you using?

I am no wound care expert by any means, but when my providers are doing debridement it is generally 97597 or 97598. In which case it doesn't matter how many wounds you have you just add up the total area.

If you are using 11040-11044, again size or number not an issue, just thickness.

I'm probably no help at all since the above are the only ones I have any personal experience with.

Laura, CPC

Well, we are using the 11040-11044, but the number does make a difference, because if there are 2 wounds debrided, you charge each of these individually. At least we do, but we do use the 59 modifier for any after the first. We are a wound care clinic with physicians attending and have never used the 97000 code series. But, one of us read somewhere that if a wound split so to speak and became 2 wounds or 3 wounds, then only one was still charged. That's where the problem lies. Is it considered one or 2 wounds if partial healing occurs.

[RebeccaWoodward*]

Anna,

I do agree with your approach with modifier 59 for multiple sites.

When reporting debridement of more than one site, the physician would report the secondary code with modifier 59 to indicate that a different area was debrided. As for the wounds "splitting off", I could see why you are charging for both debridements; especially if the depths of the wounds are different not to mention the global days change based on the depth of the debridement. You've presented a good question. I would like to hear what others say, also.

[Anna Weaver]

Has anyone thought about this or found anything to help? We are still in a dilemma as to whether or not to charge 1, 2, or 3 wounds when one has partial healing in the middle of the wound. Is it then considered 1, 2, etc. wounds? I would really appreciate any help, discussion, etc. Thanks

[mitchellde]

I am also inclined to see thia as two separate debridements. Also now you can code each site with a different stage and link each unique stage to each debridement, I am not seeing a problem with treating this as two separate wounds.

[Anna Weaver]

Thank you all for your responses. I appreciate the feed back!

[nursecpc]

Originally Posted by Anna Weaver

Okay, here's the scenario, I don't have a particular OP report, but it goes like this:

Patient has a 5 cm ulceration on the abdomen. It heals in the middle and becomes 2 small ulcerations each 2 cm. Is this then considered one wound since it's contiguous? Or is it considered two wounds since there is a healing in the middle? We need to know because of debridements. Are they going to be charged one debridement to the deepest level, or is it going to be two debridements one for each wound? I'm leaning towards one debridement since it's just opposite ends of the same wound, BUT, right now (until we can find documentation) we are charging two. We can't find anything either way, so we're basically coders choice at this point. Any help appreciated, and all comments and commentaries welcome! Please give me your opinions or any documentation you might have. Thanks!!!

Anna

Hi Anna. I work for a facility that has a wound care department. We have been through the Medicare RAC's for debridements and came out very well. My opinion is also not expert but I would say that if the wound had split before you ever evaluated the patient, you would not know that it was originally one wound. Therefore, I would feel fine about coding as two separate wounds. I have doctors dicate wounds in the same area all of the time and charge for the debridements; and as I said, we were fine on the RAC's according to Medicare. I would like some opinions on the codes 11040 and 11041 being deleted. We have never charged the 975-- codes before but it looks like we have no choice if the physician dictates partial/full thickness since the 2011 change? Any advice would be welcome.