Wiki Medicare Denial for G0281

[herb2480]

Hello

Is there anyone out there that codes for a therapist who does wound care and lymphedema therapy?

I am having trouble getting Medicare to pay for G0281- Which is electrical stimulation for chronic wounds. They are denying the claim as medical necessity not met. I can not seem to find a policy on ths code. Just wondering if anyone has any ideas on how to get this paid??

Thanks
Amanda R
Green Bay, WI

 

[CodingKing]

You may want to reference NCD 270.1

The use of ES and electromagnetic therapy for the treatment of wounds are considered adjunctive therapies, and will only be covered for chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers. Chronic ulcers are defined as ulcers that have not healed within 30 days of occurrence. ES or electromagnetic therapy will be covered only after appropriate standard wound therapy has been tried for at least 30 days and there are no measurable signs of improved healing. This 30-day period may begin while the wound is acute.