Wiki Wound Care Billing - Our hospital is going to be opening

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kfrycpc

kfrycpc

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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
 
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!
 
dana_n_andy@yahoo.com said:
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!
Click to expand...

Thanks...that is very good info :)
 
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.
 
denisezielonka said:
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.
Click to expand...

Thank you :) I was wondering about HBOT and how the payers felt about that.
 
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!!
 
kelliep said:
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
Click to expand...

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

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