Wound Care Billing - Our hospital is going to be opening

kfrycpc

Guru
Messages
150
Location
Yardley
Best answers
0
Hi all,

Our hospital is going to be opening up a wound care center mid-year and I have been asked to be the coder/biller for this venture. I'm very excited! :D I currently code and bill for our Hospitalists practice and have also done CVT and Neurology.

I wanted to ask if anyone has experience in wound care billing and if you could share any resources or information with me. Things that I should know about it. I am going to do my own research and compile a binder of helpful information and articles, etc. but wanted to reach out to the group as well.

Thanks! :)
Kellie
 
Messages
13
Location
Bettendorf, IA
Best answers
0
The size of the wound is very important, if a debridement 11042 is done it is only for 20 square centimeters. So if the wound is more than that you need to use the add-on code 11045 for each additional 20 sq cm. Medicare will zero pay for more than 5 or 6 units, but if you submit redeterminations with the proper notes verifying that the wound is in fact that large they will pay it. Good luck!
 

kfrycpc

Guru
Messages
150
Location
Yardley
Best answers
0
The size of the wound is very important, if a debridement 11042 is done it is only for 20 square centimeters. So if the wound is more than that you need to use the add-on code 11045 for each additional 20 sq cm. Medicare will zero pay for more than 5 or 6 units, but if you submit redeterminations with the proper notes verifying that the wound is in fact that large they will pay it. Good luck!
Thanks...that is very good info :)
 

dzonks

Contributor
Messages
14
Best answers
0
Hi Kelly:

If your Wound Care Center is going to do hyperbaric oxygen therapy (HBOT) it would be a good idea to train staff to have all Blue Cross/Blue Shield and United Healthcare (especially medicare advantage members) prior authorized. They consider HBOT experimental and will hold up your claims in order to review records, HPI, path reports, etc.
 

kfrycpc

Guru
Messages
150
Location
Yardley
Best answers
0
Hi Kelly:

If your Wound Care Center is going to do hyperbaric oxygen therapy (HBOT) it would be a good idea to train staff to have all Blue Cross/Blue Shield and United Healthcare (especially medicare advantage members) prior authorized. They consider HBOT experimental and will hold up your claims in order to review records, HPI, path reports, etc.
Thank you :) I was wondering about HBOT and how the payers felt about that.
 

mmorningstarcpc

True Blue
Messages
644
Location
Charleston, South Carolina
Best answers
0
You might want to review all your major carriers and their coverage policies. These will included what they cover, what they don't cover and what is needed to justify the service. If you have specific questions, you may want to speak with the carrier itself.

Good luck to you!!
 

Pipke

New
Messages
2
Best answers
0
Hi all,

Our hospital is going to be opening up a wound care center mid-year and I have been asked to be the coder/biller for this venture. I'm very excited! :D I currently code and bill for our Hospitalists practice and have also done CVT and Neurology.

I wanted to ask if anyone has experience in wound care billing and if you could share any resources or information with me. Things that I should know about it. I am going to do my own research and compile a binder of helpful information and articles, etc. but wanted to reach out to the group as well.

Thanks! :)
Kellie
Be very knowledgeable of Medicare LCD/ NCD's on wound care CPT codes .
You will proably dealing with Grafts also .,
 

bug1953

Guest
Messages
3
Best answers
0
Trish

Always check CCI edits & code from documentation I have found that the superbill that is marked very rarely matches the documentation
 
Top