Wiki Billing for Wound Care

[woleke@michigan.gov]

I have a Physician that is part of a Disease Wound Clinic that is billing for Wound Care on a patient (Codes 97597 and 97598) that has severe edematous and ulcered legs. The Physician is billing with a Place of Service of 22 (indicating Outpatient Facility). The Outpatient Facility is also billing for services on this patient and is billing Procedure Code 11042 and Revenue Code 0510.

My first concern is that the Physician and Hospital are billing two different codes, which I do not believe is correct? Can both the Physician and Hospital bill for the same services? My guess would be no, but I am not sure and am looking for some guidance.

Thank you in advance!

 

[espressoguy]

The physician bills for his professional services and the hospital bills for the facility usage.

Given that the physician is billing 97597 and the facility is billing 11042. Double check the physician's notes and if he debrided down to subcutaneous tissue then the correct code for him would be 11042.

It is possible that both CPT 97597 and 11042 use the same revenue code, in which case, the facility reimbursement may be the same for both procedures.