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Wound Care Debridement and E/M in outpatient setting

  1. Default Wound Care Debridement and E/M in outpatient setting
    Medical Coding Books
    The hospital I work for has several Wound Care Clinics, we cannot get the office visits paid because it is considered a "hospital setting" any coding advice. I have advised the coders not to code the office visit when a debridement has been done but often patients come back just for a follow up and we cannot get reimbursed on those.

  2. Default
    Quote Originally Posted by 5kelly View Post
    The hospital I work for has several Wound Care Clinics, we cannot get the office visits paid because it is considered a "hospital setting" any coding advice. I have advised the coders not to code the office visit when a debridement has been done but often patients come back just for a follow up and we cannot get reimbursed on those.
    Are you wound care clinics outpatient clinics?

    The debridement codes have different global periods... are you using the 11040-11044?

    11040-11042 have no global and 11043-11044 have a 10 day.

    If your an OP facility, we use 99024 if the follow up is within the global which is not reimbursed. It's more for internal tracking. I hope that helps.

  3. #3
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    Are you billing for the physician or the facility? If you are billing for the facility then there is no global, and the visits should be reimbursed.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    I worked hospital physician, I posted some charge for wound clinic. If have office visit I will put E/M code with modifier "PC" and "26", we got pay. Ihope is help

  5. #5
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    Columbia, MO
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    You posted a charge for the hospital clinic? or for your physician, I am sorry I am still not understanding. However you do not use a 26 modifer with the E&M and I am not familiar with a PC modifer, what is it for?

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    They are outpatient clinics and there have been some questions as to whetehr or not be should be using codes from 11040--11044 or using codes from 97597-97606, and yes your answer was helpful on the follow up visits.

  7. #7
    Location
    Columbia, MO
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    You can use codes from either section depending on what is done and who is doing it, and what revenue center you are using, for the facility billing. I agree that if the patient was scheduled to come in for a debridement and taht is what is performed then there should be bo visit level. However for the followup check for the facility there can and should be a clinic charge.

    Debra A. Mitchell, MSPH, CPC-H

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