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Wound Care @ Hospital based clinic E&M

  1. #1
    Default Wound Care @ Hospital based clinic E&M
    Medical Coding Books
    We have a podiatrist added to our group regarding wound care in a hospital based clinic. If the podiatrist treats a patient in the wound care clinic that is hospital based they can bill a new or established E&M code right? The POS would be a 22 and the site location address on the HCFA bill would be the hospital address or the physicians address? I think it would be the hospital address but want to make sure. Also , the podiatrist can't admit a patient correct? Wound care and Podiatry is new for me.
    Thank you -Edie

  2. #2
    Alot will depend on the scope of practice for the podiatrist. Some states allow podiatrists to only practice from the ankle down, others will allow from the knee down. Whether or not the podiatrist can admit to the hospital depends on whether or not the hospital has granted him/her admitting privledges. And yes, a podiatrist can provide E/M services for both new and established patients. Word of advise, check your local medicare carrier's LCDs for podiatry billing guidelines as well as wound care guidelines. Most of your third-party payers via their websites will have their medical policies available. I know specifically that Aetna, Humana, United Healthcare and I believe Cigna have policies pertaining to documentation requirements for wound care/HBO therapy. Hope this helps

  3. #3
    I will look into requirements for a wound care clinic. The doctor thinks they can bill the E&M with a POS 11 for a hospital based wound care clinic. Is this right? I thought that the POS would be a 22 since it is hospital based? Thank you.

  4. #4
    Default wound care
    Aetna have been denying our (facility) claims(ub-04) when we bill e/m 99201-99215 with a 25 modifer along with c1300x4 or 11040.
    Aetna "e/m should be on a 1500 and the facility should only be billing the c1300 or 11040. Is this correct?

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