Quote Originally Posted by mgord View Post
Is anyone billing for Wound Care Centers? These are recurring patients usually returning once a week - the doc says he must evaluate the wound before deciding for certain if another debridement is required. Based on this I have been billing the E/M level documented w -25 then the debridement. However today we had a meeting with the reimbursement director over the WCC who advised that we could only bill for both if there was another medical reason for the E/M or if a new wound was present. I thought the -25 could be used as a decision for surgery for minor procedures (0-10 day global). Is that incorrect?
It's incorrect. When the patient returns for follow up after previous debridement they already know they have a wound, the E/M must be separate and identifiable, treatment of something else, not anything associated with the wound. We ran into this same issue. The E/M must have all qualifications met, must be separate and identifiable issue (besides the wound they are presenting for) and then you can charge the E/M with 25 modifier.
I found in wound care, just about the only time we can charge E/M is for first visit when they are meeting the patient and the last visit when wound is healed.