Medical Billing Forum

Coding => Coding => Topic started by: djk on May 05, 2014, 08:02:49 AM

Title: debridement of lesions of the foot
Post by: djk on May 05, 2014, 08:02:49 AM
debridement of plantor warts--Dr. writes using a #15 blade the lesions were debrided to pinpoint bleeding, There were less fifteen lesions.

DX  078.12

What procedure code would I use its not a 11721 that is for nails and the 11055 is for callus ( would callus be the same as lesions in this instance)
Title: Re: debridement of lesions of the foot
Post by: PMRNC on May 05, 2014, 08:27:28 AM
Is the doctor even attempting to code these for you? Are you a certified coder? If you are not a certified coder I would recommend you let the physician do the coding or have them hire a certified coder.
Title: Re: debridement of lesions of the foot
Post by: djk on May 05, 2014, 09:02:27 AM
She didnt know the code, and no I am not a certified coder my  supervisor is but i try to find the code and then run it past her if i need to..
Title: Re: debridement of lesions of the foot
Post by: kristin on May 05, 2014, 10:00:09 AM
Did the doctor do anything to destroy the warts after she debrided them? If not, I don't see how the debridement of the warts is billable.
Title: Re: debridement of lesions of the foot
Post by: HeidiK on May 06, 2014, 11:25:29 PM

I'd like to try and help, but more from the perspective of how realizing how important and critical a medical coders job is as well as the equally important medical biller's role.  The two go hand in hand and when either deviates from compliance and agreements a provider is contracted to follow, it creates a very concerning situation.  When comments are made such as "I try to find the code and then run it past her if I need to" it truly can send a red flag and invite an audit. 

If you are willing to admit you aren't a certified coder, the natural question which should follow is how do you then determine when you need to "run it past" your supervisor or doctor? I also wonder how the information is getting to you without all the necessary codes if a certified coder is in the office.  Every claim should be reviewed for accuracy by her before it even leaves the office.  You might want to consider a workflow analysis if this type of situation happens frequently.  Claims unnecessarily delayed for submission ultimately result in delayed reimbursement.

Coding does not only require "finding" the right code but understanding and interpreting the coding guidelines and carrier rules and regulations.  It's very easy to become familiar with codes and for in-house staff the coding and billing duties are usually handled by the same person.  When you are an out-sourced billing service, the rules change considerably.  If you are not responsible for coding and yet you are putting codes on a service which is later found to be inaccurate or not supported by the documentation, YOU could potentially face exclusion from government programs, penalties, fines etc. just the same as the provider you work for. 

Please be careful!  It isn't worth jeopardizing your business and reputation to save time and just add a modifier, or choose a different code when you believe it is more accurate.  If your contract states you are to provide billing and submission of claims based on the source document - you should NEVER be changing that document without written approval from the provider.

Apologies to anyone not interested in following the rules - back to the original question!  :)

You offered the doctor's note and if I were responsible for coding I would need to return it for more documentation.  There simply is not enough information to accurately identify what was done. 

This link actually provides a TON of other great links for information about billing and coding for wart treatment when you find out more details:

This link is outdated, but I really liked the form they offer as a template for proper documentation.  I would offer to work with the supervisor since she is a certified coder and create an updated form relevant to the practice TOGETHER!  This shows your willingness to help and you might gain a better insight in to how the office works...

Seems as though you have an amazing opportunity to show how indispensable your service could be for this practice.  Noticing areas where improvements could or should be made is one thing, but if you can offer ideas to help it really proves your value.  Not too mention how important word of mouth advertising is - help this office get compliant and they will definitely recommend you to others.   Let me know if you need other ideas or help! :)

Title: Re: debridement of lesions of the foot
Post by: djk on May 07, 2014, 10:13:15 AM
I found the code i was looking for, the doctor does do all her own coding in the clinic i work at but could not remember the code for this procedure and asked if i would research it for her.  I am a  medical biller and not a coder if i feel something isnt coded right i go to my supervisor that is a coder and get her take on it.  I do understand the importance of coding right and interperting the doctors note properly to achieve the right code.