Excisional Debridement add on code 11045 billed to Medicare with multiple units

smsmith

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I had seen this discussed before but I wanted to get more feedback. Our surgeons work also in an outpatient wound center and do lots of debridements. I am receiving current denials from Medicare if I bill for over 4 units with an explanation: "information submitted does not support this many services" and also "number of days or units exceeds our acceptable maximum". They are paying on up to 4 units just fine, but if I bill for 5 or more, they deny. Is anyone else having this issue?

Thanks,

Susie Smith, CPC
 

strum0

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multiple wound care units

I have the same problem. Medicare told me they would have to be appealed. Refered me to MLNMM5402.
 

Grintwig

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I have seen a large number of denials for these as well. We have had to send records with a redetermination request. It's very tedious.
 

smsmith

Networker
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Yes it is! I just sent redetermination requests for 23 claims. I am also having Medicare deny 97598 when I bill it with 97597. They paid the 97597 but deny 97598, it's like they don't have their system updated to know that it is an add on code for 2011, not an either or code. So much time spent appealing for so little money.
 
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