Debridements for Medicare

[akmorgan]

Is anyone else getting denials from Medicare for the add-on debridement codes stating the units of service exceed the maximum allowed? What is the trick to getting multiple units of service paid?
Thank you in advance for help with this.

 

[JJackson506]

Need more Information

Is anyone else getting denials from Medicare for the add-on debridement codes stating the units of service exceed the maximum allowed? What is the trick to getting multiple units of service paid?
Thank you in advance for help with this.

Can you give us an example so that we may help to better answer your question.

 

[akmorgan]

One case we have is a patient that had 536 sq cm of debridement performed.
Codes used: 11043 and 11046 x 26 units

Medicare has denied 11046 stating the number of days or units of service exceeds the acceptable maximum.

My thinking is that since it is an add-on code per 20 sq cm, this could should not have a limit.

 

[theresadickson]

Send pictures!

I actually called Trailblazer and asked them why they denied the add on code. I was told there was no way the debridement could have been as extensive as what we billed. Thank I sent the picture of the leg of the 5 foot, 250 plus patient with the extensive debridement, as well as documentation for the wound therapist who also treated the leg,
that described the exact same measurements as my surgeon. They paid.

 

[valleycoder]

We've been getting these denials and I found a conversation on another forum that suggesting billing no more than 3 units on each line. We're going to try that.

 

[AFELDKAMP]

I was getting denials also so now anytime I am going to code more than 3 units per line for these I add a box 19 note "addl information available upon request". We provide the op note and then we get paid.