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initial surgical exposure

  1. #1
    Location
    Glendale Arizona
    Posts
    10
    Default initial surgical exposure
    Medical Coding Books
    My office is having trouble appealing our billings of wound closure codes. According to our "Complete Global Service Data for Orthopedic Surgery" published by the American Academy of Orthopedic Surgeons we can bill for wound closures as long as it is NOT for initial surgical exposure (like and I&D of an abscess) and our "deniers" are still refusing to pay. They are stating that once we touch the wound it automatically becomes a "surgical site" and therefore the traumatic wound becomes our site of exposure. We are only billing for these closures when the patient presents on the first treatment day and we are the only surgeons to touch the wound. If another physician has sutured or performed debridement, or packed the wound we do not bill because now it is a surgical site. If the wound is extended for tendon repairs we do not bill for what we incised but rather they only bill the traumatic portion. Are we in the wrong or do we have a valid point? Please comment, if you can include your credentials and any resources you are aware of to support this in either direction it would be appreciated. We just want to do the right thing and if that means not billing for the closures then that's ok. Thanks!

    Karen Hayen, CPC
    Karen Hayen, CPC

  2. Default
    Quote Originally Posted by karenhayen View Post
    My office is having trouble appealing our billings of wound closure codes. According to our "Complete Global Service Data for Orthopedic Surgery" published by the American Academy of Orthopedic Surgeons we can bill for wound closures as long as it is NOT for initial surgical exposure (like and I&D of an abscess) and our "deniers" are still refusing to pay. They are stating that once we touch the wound it automatically becomes a "surgical site" and therefore the traumatic wound becomes our site of exposure. We are only billing for these closures when the patient presents on the first treatment day and we are the only surgeons to touch the wound. If another physician has sutured or performed debridement, or packed the wound we do not bill because now it is a surgical site. If the wound is extended for tendon repairs we do not bill for what we incised but rather they only bill the traumatic portion. Are we in the wrong or do we have a valid point? Please comment, if you can include your credentials and any resources you are aware of to support this in either direction it would be appreciated. We just want to do the right thing and if that means not billing for the closures then that's ok. Thanks!

    Karen Hayen, CPC
    Here are two sites I found that might help you. And I copied alittle paragraph from each site.
    Hope that helps.
    Melissa, CPC

    http://www.podiatrytoday.com/article/3037
    Anthony Poggio, DPM
    Read down until you get to:
    Getting A Handle On Coding For Wounds:

    Repairs involving additional work beyond multiple-layered closure such as tissue undermining, significant tissue debridement and cleaning are considered “complex.” With such wounds, additional wound care of traumatized or exposed nerves, blood vessels tendons, muscle, etc., may be payable separately.

    http://www.immediatecarebusiness.com...11billing.html
    Sheri Poe Bernard, CPC, CPC-H, CPC-P

    Laceration repairs have a global period of zero to 10 days. Know which codes have a 10-day rule and understand that followup care within the global period cannot be billed. Follow-up care only includes care that is usually a part of the surgical service, like dressing changes, incision care, suture removal, or wound cleansing. According to CPT guidelines, infections, wound dehiscence, complications or new conditions can be separately reported.

  3. #3
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    can you post sample documentation and the codes that you used that are being denied for a particular case?

    Mary, CPC, COSC

  4. #4
    Location
    Glendale Arizona
    Posts
    10
    Default
    11012-51 debride op fx
    14040- vy flap
    11760-51 nail bed repair
    12002-51 simple wnd cl

    11044-51 debirde to bn
    26418-51 tend repair
    14040-51 att
    15120- stsg
    12002 -51 simple cl

    All scenarios are quite similar since we focus on hand alone....let me know if you need the documentation and I'll try to cut and paste but they are scanned documents so I havn't had the time to figure out how to do that exactly....Thanks for your help!
    Karen Hayen, CPC

  5. Default
    Quote Originally Posted by karenhayen View Post
    11012-51 debride op fx
    14040- vy flap
    11760-51 nail bed repair
    12002-51 simple wnd cl

    11044-51 debirde to bn
    26418-51 tend repair
    14040-51 att
    15120- stsg
    12002 -51 simple cl

    All scenarios are quite similar since we focus on hand alone....let me know if you need the documentation and I'll try to cut and paste but they are scanned documents so I havn't had the time to figure out how to do that exactly....Thanks for your help!


    If you can get documentation that would help, but just by looking at those codes, simple repair (12002), and (11760) are not billable, unless they are done on a different part of the body other than the prime procedure, and the second scenario 12002 would not be billable, unless done on a different part of the body, and the 11044 is questionable.

  6. #6
    Location
    Columbia, MO
    Posts
    12,867
    Default
    I agree, Documentation would be very beneficial for the analysis.

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