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Wound Care

  1. #1
    Default Wound Care
    Medical Coding Books
    I am finding different people have different opinions on this subject here at work so I would like your opinion.

    Patient presents to a wound care clinic to have a recurrent wound evaluated. Our general surgeon evaluates the wound and decides at that visit that the wound should be debrided. They document a complete E & M visit (99213), which includes all risk factors and extensive wound evaluation. Then he completes a debridement of the wound. I do agree that this constitutes an E & M service. This is a NEW recurrance of this wound and it is the first time the physician has even seen this wound since it has re-presented. He tells the patient that they will need to come back for a follow up visit, to look at the progress of the wound and to see if the treatment has been successful.

    Patient then presents for the follow up visit. The wound is evaluated again and is improved, however the physician thinks that a second debridement is needed and performs it the same day.

    Do you think that the follow up visit should be billable with a 25 modifier? I am a tad torn on this subject.

    Last edited by MandyFlagg; 09-07-2011 at 09:01 AM.
    Mandy Flagg, CPC, CEMC
    Compliance Auditor

  2. #2
    follow guidelines for modifier 25:
    CPT modifier -25 is used when, on the day a procedure or service was performed, the patient’s condition required a significant, separately identifiable evaluation and management (E&M) service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.

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