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Wound Care Billing/Coding

  1. Default Wound Care Billing/Coding
    Medical Coding Books
    Can someone give me some key points to remember on the physician and facility side of wound care billing and coding?

    Thanks

  2. Default reply
    I'm no expert....but I just started billing on the side for Infectious Disease Dr. for wound care.

    If patient was seen inpatient you would not bill for supplies, just the hospital visit, and anything else like debridement etc. Location code 21

    In the office you can bill for the supplies with some of the insurance companies. Location code 11

    Facility outpatient would follow as the same as hospital.... location code 22

    Here is an example what my provider codes 99213 wih a 25 modifier and 97597. Don't know if that answers your question or not. Good Luck. If your provider is a member of one the speciality organizations, you can call them for questions, and they will help you.

    Jenny

  3. Default
    One thing that I try to remember: for each procedure where and LCD exists in states where the part A and part B sides are not the same MAC, that different diagnosis codes will be accepted for different procedures. i.e. 459.81 might be payable for an allograft under part A but not under part B. Ultimately this issue should go away once all the MACs are awarded but I have seen part A claims get paid and part B claims be denied for this reason on the same procedure.

    Hope that helps!
    Jacqui

  4. #4
    Default
    First and foremost, educate yourself on the difference between Selective Debridement (97597-97598) and Excisional Debridement (11040-11044). Also, be careful when using the modifier -25. Make sure the debridement wasn't planned a head of time before using a f/u cpt code. The patients condition must require an E/M service "above and beyond" that of the procedure, that is significant and seperately identifiable. One more thing, if the doctor evaluates a patient post operatively at the wcc.... still a global situation.

  5. #5
    Smile
    Make sure your Physician documents the depth of the debridement: You can't bill 11044 just because he saw bone. He has to take it out. --tell them to dictate a picture of the wound, we tell our dr's we want description good enough for us to draw picture. Depth, width, color, what they see and touch.
    DX codes are important. make sure you stage ulcer/decub.
    Wound care is a big issue red flag audit as soon as they see codes.
    Know your LCDs
    Good luck
    Kathy

  6. Default wound care -Dermagraft
    Can the physician also bill an E/M code with a mod 25 when he treats with Dermagraft?
    New to wound care!!!
    Thanks,
    Annette McGee

  7. #7
    Default E&M and a minor procedure on the sameday
    For Medicare and some commercial carriers the pre op and post op are include in the minor procedure.

    To bill an E&M and the procedure on the sameday you would want to make sure the E&M supported the necessity above and beyond what is included in the procedure.

    Medicare clearly conveys that just because they are a "New patient" does not warrent an E&M and the procedure alone.

    This is a grey area and I would recommend discussing with your provider to determine what is included in the procedure and what is above and beyond co-mordity that affects treatment options, infection requiring antibiotic are some good examples. Needs to be clearly supported in the note.... not just pt. has diabetes but how the diabetes affects the condition for the procedure.

    However you choose to handle this remember adding the 25 mod. opens the claim for review even if they pay it does not make it correct it may mean that it bypassed the edits. So you want to make sure the E&M is supportive.

    Hope this helps,
    WSRCPC

  8. #8
    Default WOund Care billing
    Great info! Thanks for that. I will start Wound Care billing
    CC


    Quote Originally Posted by kbarbag View Post
    Make sure your Physician documents the depth of the debridement: You can't bill 11044 just because he saw bone. He has to take it out. --tell them to dictate a picture of the wound, we tell our dr's we want description good enough for us to draw picture. Depth, width, color, what they see and touch.
    DX codes are important. make sure you stage ulcer/decub.
    Wound care is a big issue red flag audit as soon as they see codes.
    Know your LCDs
    Good luck
    Kathy

  9. Default Wound Care In Nursing Homes
    Our doctors only see nursing home patients. When one of our patient's gets a wound that cannot be handled by the nursing home nurses, a "wound care company" comes in to take it from there. They are billing Part B, but how can you do that with a place of service 32 or 31?

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