Wiki WPS and wound debridement code

[belindapearl]

We are having some real issues with codes 11043 and 11044. Mid last year WPS stated this can no longer be done in the office setting. So we started doing them in an ASC place of service 24. They are still denying for invalid place of service. I spoke to a Medicare rep who informed me that the only place that this was valid is 21 (inpt hosp) and 22 (ot pt hosp) and that when we did do this level of debridement in an ASC or office that they would request the op note and it goes directly to the Medical Director for a decision if it is payable or not. WPS is not consdiering an ASC as outpatient (which is insane). This does not make sense to me. I also have done ASC billing and this is a payable code for them, so why not the physcian?

We have not yet been paid for these 2 codes, (still pending). I feel that WPS is kinda picking on Podiatry for wound debridement. Do they not realize how important it is? If not treated patients end up with amputations.

Beside complaining I guess my question is does anyone know who I could contact to complain about this issue? I appealed one, but was returned with the explaination that no appeal rights are affordable because it was denied as a MA130 which means no appeal rights.

 

[KimberlyLanier]

Denial's

I have not had that kind of issue before, but I in the past had issue when I was doing Radiology Coding, we was having problems getting paid by United Healthcare, and so I contacted the Insurance Commision, you may want to try that, explain the problem to them and they will do an investagation.

 

[TammyHF]

According to the currect WPS LCD 11043 and 11044 will only be paid if performed in a in patient or out patient hospital setting.