Wiki 11045 and Medicare units allowed

[lwcarter]

Can anyone tell me how to find out how many units of this add on code are within the MC acceptable maximum? I've looked at all the resources within codecorrect and at the CMS.gov website with no help.
Thank you.

 

[jmcpolin]

I do not see that there is an MUE edit on that code, but there could be one internally that is not posted, I am not quite sure why some of the codes are kept "secret". Have you been recieving denials for more than one?

 

[BabsCPC]

I don't see anything either. Everything I see is showing " each additional 20 sq cm" but nothing with max units.
Barbara Borntreger CPC

 

[OCD_coder]

This is very very tricky. There is nothing published on this topic and the MUE edits don't help us either. You probably have been getting denials for "maximum number of units exceeded or allowed".

We recently had a chapter member share with us that she found through trial and error that the maximum number of units you can bill is in increments of 4 at a time. She did state she found an obscure article that described billing this way. I am sorry I don't have the source, so if anyone finds it and would share - it would be greatly appreciated.

So if you have a total of 13 units, you would bill your primary code and 3 separate lines of the 11045 with a maximum of 4 units per line, with a mod-59 on each subsequent line. This is how MCR wants it billed for debridement codes. Don't bill your laceration repair codes this way, only wound debridement codes.

Hope this helps.

 

[dactew]

A newly introduced coding concept related to the reporting of wound débridements is also significant. The code range 11040–11044 has been completely revised; the major changes are as follows:

•CPT codes 11040 and 11041 have been eliminated; they are replaced by CPT codes 97597 and 97598 as appropriate for débridement of dermal and epidermal skin layers. Check the manual for the new definitions.
•The reporting of wound débridement is now based on the depth of tissue débridement and the size of the wound in square centimeters.
•Surgeons must “sumâ€� the surface areas of multiple wounds of the same depth; each wound should be reported separately if the tissue débridements are of different depths.
•New add-on codes (11045, 11046, and 11047 for each additional 20 sq cm, based on the depth of the débridement) were introduced.
As a result of these changes, CPT code 11042 now reads, “Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less.� The associated new add-on code 11045 should be reported for each additional 20 sq cm or part thereof.

Additionally, the surgeon's documentation must include the size of the wound(s) (eg, 4 cm x 5cm) and the depth of tissue débridement for each individual wound for which the procedure is performed.

The guidelines for the repair (closure) codes were revised related to the definition of a complex repair, and the definition of débridement and services included have been added to the repair codes. Surgeons performing complex repairs are now allowed to report this work separately when done in conjunction with débridement codes, excision of benign or malignant lesion codes, excisional preparation of a wound bed codes, or débridement of an open fracture or open dislocation codes.

Changes to the skin substitutes guidelines reinforce the range of codes that are “skin substitutes� and include specific instructions for using these codes. As an example, skin substitute codes should not be reported when the products are used as mesh or for internal reconstructive work such as a rotator cuff repair. These codes should only be reported when the product is used as a skin substitute.

This is from the AAOS website. Hope it helps. Also there is a handy dandy spreadsheet on the aaos website with the changes. One other link is Highmark Medicare Services websitehttps://www.highmarkmedicareservices.com/articles/mac-ab/a47793-r6.html this should take you directly to the article.