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Debridements of venous stasis ulcers

  1. Default Debridement
    Exam Training Packages
    I bill them this way: Now that the MUE is corrected, you shouldn't have any problem with payment.

    1. Add all the wounds of the same depth together
    2. subtract the first 20 sq cm and pick your primary code from the wound depth
    3. divide the rest of the area by 20 to figure out how many units of the add-on code to bill
    4. Bill the add-on code x that quantity

    so in your example-
    11042 x 1(first 20 sq cm of subq)
    11045 x 2(40sqcm/2)
    11043 x 1 (first 20 sq cm of muscle depth)
    11046x 1 (additiona 20 sq cm of muscle depth)

    The primary codes are:
    11042 sub q
    11043 muscle
    11044 bone

    So you have to bill one of the above codes before you can bill their partner add-on code for the extra sq cm.
    11042 -add on code is 11045
    11043- add on code is 11046
    11044 - add on code is 11047

    On your hcfa, always bill
    the primary code x1
    the add on code x correct quantity (remaining area/20)
    the primary code x 1
    the add on code
    So the system will find the code as the payment edits work through

    Good luck!

  2. #12
    Cherry Hill, NJ
    Modifiers are not used on add on codes you should not receive denials.

  3. #13
    Who is your MAC? I am in TN and we go through Cahaba. The denials we recieved on the add on codes were all refiled after April 1 and we are still getting denied. I checked and see that the MUE has been updated but it doesn't seem like their system is updated yet.
    Mary Beth Gord, CPC

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