Wiki 11042 CPT code

[tscobee]

Does anyone know why Cigna Healthspring would deny 11042 saying procedure code was invalid on date of service?

 

[SharonCollachi]

Is it during a surgical global period? Is the patient under a Home Health plan of care? Is the patient in a facility?

 

[tscobee]

Is it during a surgical global period? Is the patient under a Home Health plan of care? Is the patient in a facility?

It was an outpatient wound care facility. I'm not sure if they are under a home health plan.

 

[SharonCollachi]

Well, if it's during a global period of care, then that would be a problem. The care of a post-op wound is done by the surgeon within the global period. If the wound is ongoing and is referred out after the end of the global period, then it is paid separately.

If the patient is under a Medicare Home Health Episode of Care, you'll need to check if the Home Health Agency is supposed to be providing these services. I know that wound care is included in this, but I cannot recall is debridement is included.

 

[thomas7331]

Does anyone know why Cigna Healthspring would deny 11042 saying procedure code was invalid on date of service?

The code is not invalid - it has been a valid CPT code for many years now - so the denial message is clearly an error on Cigna's part. There are, of course, any number of other legitimate reasons that they could have denied the claim, but this is not one. Rather than try to guess or make an assumption about what they are actually thinking here, I would contact them for clarification.