Wiki Hyperbarics and debridement: same physician/day

[kgrantham@wkhs.com]

How would you code for a physician who performed supervision of hyperbarics for a diabetic foot ulcer with osteomyelitis, and also debrided the wound to subcutaneous level ( <20 sq cm.) in the same day?

99183, 11042-59 modifier?


What are your thoughts on the coder not submitting the 11042 because "insurance will not pay for hyperbarics and debridement?"


Thanks

 

[ElaineM]

You should definitely bill both.
The hyperbaric oxygen supervision (99183) can be billed with the osteomyelitis dx code only, and bill the derbridement (11042) with the ulcer code.

I used to work in a wound clinic, and the insurance should be paying for both codes on the same day. If not, appeal it with notes.

Some carriers have a system edit that automatically kick out the HBO codes, so this could be part of the problem.

Elaine
CPC, CEMC, CPMA

 

[kgrantham@wkhs.com]

Would you use the 59 modifier at all?

Thank you for your help!