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Thread: Debridement - Wound Care

  1. #1
    Join Date
    Apr 2007

    Default Debridement - Wound Care

    AAPC: Back to School
    Has anyone had any problems with reimbursement for debridement of large wound areas? i.e. greater than 100 sq. cm. I would be willing to talk about it. Thanks.

  2. #2
    Join Date
    Apr 2007
    St. Louis West


    We have one that just came up today and our orthopaedic surgeon was considering charging for wound care instead of the surgical I & D codes because he also put on a wound vac. Can you charge both?? I don't really think so, but it's been so long that I have forgotten. This took a long time and the wound was a motorcyclist's degloving of the skin on the thigh. It was 25 x 25 cm's so pretty huge!! Any thoughts on this one??? PS - It's been a LONG time since I had a question. I'm usually on the answering end of things!!
    [COLOR="DarkOrchid"]Barbara Fontaine, CPC
    2011-2015 AAPCCA [B]Past Board of Directors Chair

    COLOR="Blue"]Assume Positive Intent...Be Kind!

    Past President St. Louis West Chapter

    email: bfontaine@signaturehealth.net

  3. #3
    Join Date
    Apr 2007
    Fayetteville, NC


    We do alot of debridements and yes we have had trouble when we get into the larger ones. Palmetto GBA seems to target certain debridement codes to have issue with. WHen we do a 11043 + 11046 (with multiple uses of the 11046) they like to deny for lack of modifier on the 11046. I can't even count how many times I have had to explain to one of the ladies in the insurance department that 11046 is an add-on code and does not need a modifier.
    It's even worse when we do several different debridements like a subq debridement on the left leg and a fascia/muscle debridement on the right leg or something similar and each of them 40 or more square centimeters.
    It can be very frustrating. At least since we switched to Palmetto GBA as the Medicare contractor in our area we can fax notes in when we file the claim. Every now and then that does seem to help speed up the reimbursement process.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

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