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RebeccaWoodward*

RebeccaWoodward*

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Do I understand this correctly?



97606….

R عR If billed by a hospital subject to OPPS for an outpatient service, these HCPCS codes –also indicated as “sometimes therapy” services - will be paid under the OPPS when the service is not performed by a qualified therapist and it is inappropriate to bill the service under a therapy plan of care. They are billed by practitioners/providers of services who are not therapists, i.e., physicians, clinical nurse specialists, nurse practitioners and psychologists; or they are billed to fiscal intermediaries by hospitals for outpatient services which are performed by non-therapists as noted in Note RR" ع” above

My Orthopedic surgeon charged for this procedure in addition to his other surgical procedures. It appears, from this excerpt, that he is not allowed to charge for this. Am I correct?


http://www.cms.hhs.gov/manuals/downloads/clm104c05.pdf

Page 30
 
Thanks Mary...

I have some new physicians and my standard "thinking" has flown out the window. Everyday, I have emails, communication sheets and phone calls asking..."What IS this???". Although I truly enjoy their enthusiasm and creativeness, it's creating soooo much research.

Thanks again!
 
Do you believe this would this be the same for all payers? I have a doc who is wanting to bill this as well along with other surgical procedures. He doesn't believe this is "bundled" and wants me to provide documentation that he shouldn't be doing this, is there anywhere I can find this other than Medicare? I found http://www.aaos.org/news/aaosnow/mar08/managing1.asp but this has me more confused, this reads like you can bill it. I feel that a surgical wound created by the physician, should not be billed separately, am I wrong here?
 
I just posted the question on another list-serve..I post the reply (hopefully from Margie Vaught) once I receive it.
 
This is a response I received from another list serve...

"According to the JUne 2005 CPT Assistant, these codes are reported by licensed nonphysician professionals (eg, physician assistants, nurse practitioners, enterostomal therapy nurses, wound care nurses, physical therapists) licensed to perform these procedures. Only those individuals licensed by a particular state to perform the described services should use the codes to report services. For wound debridement performed by physicians, see codes 11040-11044."

:)
 
At our facility, in order to charge this, it had to be a separate anatomical site from a procedure with appropriate modifier. Also, same for E/M, separate and identifiable with appropriate modifier.
I'm looking for documentation.
 
CPT assistant June 2005 talks about use of 97605 and 97606, but only in regards to having teh skin cleansed thoroughly and prepared for application of transparent film.

There is an article also in CPT assistant April 2005, but nothing definitive in either of these.

found this site also
http://www.supmedmgmt.com/medical-wound-care-coding.php

Active Wound Care Management
Per CPT, utilize codes 97597-97606, when removing devitalized and/or necrotic tissue from wounds to promote healing. These codes should be used when just treating the surface skin of a wound, and are NOT to be billed in addition to a debridement. Report appropriate skin debridement codes (11040-11044) to reflect appropriate level (i.e. skin, tissue, muscle)

I think a lot of this is interpretation (except the one above), and our interpretation agreed with above. Only one code per wound basically.
 
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