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I queried our medicare contractor (WPS) for information regarding the use of 11042 for weekly wound debridements - typically for our diabetic and decubitus ulcer patients. They sent me the following information...
"To help me answer your questions, I consulted with Medicare Policy staff for clarification. WPS Medicare Medical policy staff indicated that the CPT coding system does not recognize “serial debridement.” CPT codes 11042 and 11043 are normally billed once. Following the use of 11042/11043, follow up CPT codes 97597 and 97598 are appropriate. This decision was made after the WPS Medicare Carrier Medical Director (CMD) reviewed claims and documentation such as medical records and operative reports for over a period of two years."
They basically state 11042 for subcutaneous debridement should be billed once, then we are to use 97597-97598 codes for weekly treatment thereafter. We disagree with this assessment as does our physicians as they are performing work that exceeds those codes. Do you have any advice on where to start appealing this decision?? It's not specifically in their LCD, but in the billing guidelines link at the end of policy.
Thanks,
Melissa
"To help me answer your questions, I consulted with Medicare Policy staff for clarification. WPS Medicare Medical policy staff indicated that the CPT coding system does not recognize “serial debridement.” CPT codes 11042 and 11043 are normally billed once. Following the use of 11042/11043, follow up CPT codes 97597 and 97598 are appropriate. This decision was made after the WPS Medicare Carrier Medical Director (CMD) reviewed claims and documentation such as medical records and operative reports for over a period of two years."
They basically state 11042 for subcutaneous debridement should be billed once, then we are to use 97597-97598 codes for weekly treatment thereafter. We disagree with this assessment as does our physicians as they are performing work that exceeds those codes. Do you have any advice on where to start appealing this decision?? It's not specifically in their LCD, but in the billing guidelines link at the end of policy.
Thanks,
Melissa