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Wound Care Coding - I have a question regarding

  1. #1
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    Fargo, North Dakota 70102
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    Default Wound Care Coding - I have a question regarding
    Medical Coding Books
    Wound Care & Debridement Codes

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    I have a question regarding wound care and it's associated procedure codes. If we have midlevel providers (PA's and NP's) seeing patients in the clinic setting, are they able to bill the surgical debridement codes (11042-11044)? I've seen articles stating that the surgical debridement codes are to be used when general anesthesia is necessary to perform the debridement, and that the 97597 and 97598 are intended for wound care in the clinic by non-physician providers. Anyone have any advice. I don't see any LCD's for ND Medicare.

    Thanks,
    Rhonda

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by RhondaJohnson View Post
    Wound Care & Debridement Codes

    --------------------------------------------------------------------------------

    I have a question regarding wound care and it's associated procedure codes. If we have midlevel providers (PA's and NP's) seeing patients in the clinic setting, are they able to bill the surgical debridement codes (11042-11044)? I've seen articles stating that the surgical debridement codes are to be used when general anesthesia is necessary to perform the debridement, and that the 97597 and 97598 are intended for wound care in the clinic by non-physician providers. Anyone have any advice. I don't see any LCD's for ND Medicare.

    Thanks,
    Rhonda
    Your ND - LCD is L24374 but there is nothing in it about limiting who can do debridements. There is a listing of accepted dx codes in the LCD.

    This is a copy of the description and coding tips in Encoder Pro for 11042 nothing about general anesthesia.

    11042
    "The physician surgically removes foreign matter and contaminated or devitalized subcutaneous tissue (including epidermis and dermis, if performed) caused by injury, infection, wounds (excluding burn wounds), or chronic ulcers. Using a scalpel or dermatome, the physician excises the affected subcutaneous tissue until viable, bleeding tissue is encountered. A topical antibiotic is placed on the wound. A gauze dressing or an occlusive dressing may be placed over the surgical site. Report 11042 for the first 20 sq cm or less and 11045 for each additional 20 sq cm or part thereof. "

    "Coding Tips

    Code 11045 is a resequenced code and will not display in numeric order.When reporting debridement of a single wound, the deepest level of tissue removed determines the correct code. The debridement of multiple wounds at the same tissue level may be added together to determine the appropriate code. Different tissue depths should not be added together for code selection. According to the AMA, the debridement of skin (epidermis/dermis) is reported with the codes describing active wound care management (97597 or 97598). Surgical trays, A4550, may be separately reimbursed by third-party payers. Check with the specific payer to determine coverage. "
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    My Physicians are doing wound care at a hospital outpatient facility. They will also be using a Bariatic Chanber as well. I wanted to know if you can charge and E&M code using a midifer 25 with the debriedment codes using a modifier 59? I have been told we can only charge a New Patient E&M code with a debriedment code. Any thoughts on this??
    CPeele

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