Wiki Wound Care

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aweaver74

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Chandler, TX
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Can a provider bill for a 11042 on the same day as a 11043 if the diagnosis codes are different? I am getting denials from Medicare stating that the 11042 is not covered when performed during the same session/date as a previously processed service for this patient.

example:

Billed a 11042 dx 707.03, 707.24, 250.80 and a 11043 dx 707.14, 250.60.
 
If it's for a different wound, in a different area, then you should be able to. For example if one wound is on the left leg, and the other is on the right hip, then you can differentiate with the -LT or -RT modifiers.

The diagnosis can be the same, but the location has to be different. We also append -59 to indicate that they should bypass the edits.
 
Pam Brooks said:
If it's for a different wound, in a different area, then you should be able to. For example if one wound is on the left leg, and the other is on the right hip, then you can differentiate with the -LT or -RT modifiers.

The diagnosis can be the same, but the location has to be different. We also append -59 to indicate that they should bypass the edits.
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I agree with the -59 modifier to indicate a separate and distinct procedure, but you can't have a left and right skin.
 
Yes, will need modifier 59. It may still deny for some other type of edit, but that will likely mean that you'll need to do re-determination so that you can send records to support the services billed.
 
97606

Can my provider bill for a wound vac 97606 on the same day as a debridement? She did 11044 x1 and 11047 x3 and applied the wound vac 97606 for a stage iv pressure ulcer of the sacrum which also has a staph infection in the wound and the patient has diabetes. The provider also billed for a 11042x1 for a pressure ulcer on the left heel.

I am in Texas and I have looked at the LCDs but I cannot find anything clear as to if I can bill a wound vac with debridement on the same day.

Thank you in advance for your help.
 
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