Wound care coding: What you should know?

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Wound care coding What you should know?
Accurate coding in wound care is necessary,
mainly for dressing changes and debridement, so
your wound care facility can get optimal
reimbursement for services. Providers need to
locate the contractor in your area. When
providers provide wound care services for
patients with private insurance, providers should
obtain policy guidelines similar to those of the
Centers for Medicare and Medicaid Services
(CMS). If we break down LCD by sections then you
can see what information you should learn and put
into practice when providing the services that
the policy covers. Providers need to use the
policy guidelines to understand and evaluate the
documentation process and in adding info into the
EHR note template in order to add all of the
documentation necessities, and support claims
filing in order to meet the medical
requirements. Codes for Dressing
Changes According to CMS, A dressing change may
not be billed as either a debridement or other
wound care service under any circumstance (e.g.,
CPT 97597, 97598, 97602).
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Wound care coding What you should know?
If we check for Medicare, they do not pay
separately for dressing changes. Actually, they
pay services as part of billable E/M or procedure
that frequently occurs on the same Date of
Service as the dressing change. Providers should
include all topical applications, medications,
dressings, and ointments used in the office on
this Date of Care in the payment for the
procedure or visit. We all know that its not
correct to use an Advance Beneficiary Notice of
non-coverage to circumvent the issue of bundled
payment. Its only correct to provide an ABN of
non-coverage for services that you think that
could deny due to the absence of medical
necessity. As the cost of the dressing change is
bundled with other services billed, it would not
right to use an ABN of non-coverage to collect
payment for the dressing change. In terms of
defining medical necessity, CMS states,
Providers must document the medical necessity
for all services provided. If there is no
documented evidence (e.g., objective
measurements) of ongoing significant benefit,
then the medical record documentation must
provide other clear evidence of the medical
necessity for treatments. The medical record must
also clearly indicate the complexity of skills
required by the treating practitioner/clinician.
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Wound care coding What you should know?
Reimbursement for Re-evaluation/Reassessment of
Wounds Generally, other than an initial
evaluation, the assessment of the wound is an
integral part of all wound care services codes,
and remember these assessments are not separately
billable. Initial wound assessment can receive
separate reimbursement from payers by using the
E/M code. This does not need a 25 modifier in
general unless your carrier state
requires.   Debridement Codes CPT Code
11042 Debridement, subcutaneous tissue. This
includes the debridement of the epidermis and
dermis, if performed, for the first 20 cm2 or
less. CPT Code 11043 Debridement, muscle,
and/or fascia. This includes debridement of
epidermis, dermis, and subcutaneous tissue, if
performed, for the first 20 cm2 or less.
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Wound care coding What you should know?
CPT Code 11044 Debridement, bone. This covers the
debridement of epidermis, dermis, subcutaneous
tissue, muscle, and/or fascia, if performed, for
the first 20 cm2 or less. CPT Code
11045 Debridement, subcutaneous tissue. This
includes the debridement of epidermis and dermis,
if performed, for each additional 20 cm2 (list
separately in addition to the code for the
primary procedure). CPT Code 11046 Debridement,
muscle, and/or fascia. This pertains to
debridement of the epidermis, dermis, and
subcutaneous tissue, if performed, for each
additional 20 cm2. List this separately in
addition to the code for the primary
procedure. CPT Code 11047 Debridement, bone.
This includes debridement of epidermis, dermis,
subcutaneous tissue, muscle, and/or fascia, if
performed, for each additional 20 cm2. List
separately in addition to the code for the
primary procedure.
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Wound care coding What you should know?
CPT Code 11055 Paring or cutting of benign
hyperkeratotic lesion. This pertains to corn or
callus for a single lesion. CPT Code
11056 Paring or cutting of benign hyperkeratotic
lesion. This pertains to corn or callus for two
to four lesions. CPT Code 11057 Paring or
cutting of benign hyperkeratotic lesion. This
pertains to corn or callus for more than four
lesions. CPT Code 97597 Debridement. This
pertains to the use of a high-pressure water jet
with/without suction or sharp selective
debridement (with scissors, scalpel, and forceps)
for an open wound, (e.g., fibrin, devitalized
epidermis and/or dermis, exudate, debris,
biofilm), including topical application(s), wound
assessment, use of a whirlpool, when performed
and instruction(s) for ongoing care, per session
of total wound(s) surface area for the first 20
cm2 or less.
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Wound care coding What you should know?
CPT Code 97598 Debridement. This covers
high-pressure water jet with/without suction or
sharp selective debridement (with scissors,
scalpel, and forceps) for an open wound, (e.g.,
fibrin, devitalized epidermis and/or dermis,
exudate, debris, biofilm), including topical
application(s), wound assessment, use of a
whirlpool, when performed and instruction(s) for
ongoing care, per session of total wound(s)
surface area. It pertains to each additional 20
cm2 or part thereof. List separately in addition
to the code for the primary procedure.   Wound
Care billing finds it difficult to integrate the
constant changes and so, outsourcing could prove
an effective option. At Medical Billers and
Coders, we offer quality wound care billing
services nationwide. Give us a call to
discuss all your worries related to wound care
billing.