Question Wound vac and Home Health

Lunap99

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We get patients occasionally, who are getting wound vac treatments with a home health agency then they come in to our office about once a week for a check in. Our provider then applies the wound vac at this appointment. I heard that we can't bill Medicare for wound vac if they are getting it done with Home Health as well.
Does anyone have some insight on this situation or can point me to some documentation on this particular situation?
Thanks
 
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Pam Brooks

True Blue
Local Chapter Officer
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It depends on whether the HH Agency is billing TOB 032X under consolidated billing with a plan of care. If they are, the payment for the wound vac services is included in the PPS payment, and shouldn't be reimbursed to another physician. CMS recommends (haha) that if a provider does wound therapy to a patient receiving home health under a plan of care (and remember, this means that they are home-bound and shouldn't be gallavanting off for treatment outside the HHA plan), the HHA needs to reimburse the provider.

So you heard correctly.
 

Lunap99

Networker
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It depends on whether the HH Agency is billing TOB 032X under consolidated billing with a plan of care. If they are, the payment for the wound vac services is included in the PPS payment, and shouldn't be reimbursed to another physician. CMS recommends (haha) that if a provider does wound therapy to a patient receiving home health under a plan of care (and remember, this means that they are home-bound and shouldn't be gallavanting off for treatment outside the HHA plan), the HHA needs to reimburse the provider.

So you heard correctly.
Could you point me to some documentation?
I'm sure they must if they are doing Home Health but if there is no care plan, and they are getting the wound vac both at home and in the office, would they both be able to bill?
 

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
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Location
South Berwick, ME
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CMS' IMO Manuals discuss Home Health coverage and claims processing. Also, the Uniform Billing Editor has information as well.
 
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