Author Topic: Billing for Wound Care  (Read 2511 times)

cheryllesch

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Billing for Wound Care
« on: January 06, 2011, 03:37:47 PM »
Hi
I am new to this forum hope someone can help.
I work for wound care doctors seeing patients in their homes. Beginning 1/1/11,  The AMA changed the descriptions for the debridement codes of 11040-11042. They deleted the codes 11040 &41  and changed
11042 to 20 sq cm or less and added an additional code of 11045 for each add'l 20 sq cm

Would anyone know if the correct way to bill   for 70.1 sq cm.   would it be 11042 and then 11045, twice or quantity?
the descriptions also for active wound care 97597 and 97598 have changed also.  I am in Michigan .
thanks Cheryl

oneround

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Re: Billing for Wound Care
« Reply #1 on: January 10, 2011, 11:48:37 AM »
70.1 cm

11042 for first 20 sq cm or less
11045 x 3 to capture the remaining


(11042 = first 20 cm/11045 = second 20 cm/11045 = third 20 cm/ 11045 = remaining 20 cm or part of in this case the remaining 11.1 cm)

Verify your exact chart description with your inhouse coder
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

cheryllesch

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Re: Billing for Wound Care
« Reply #2 on: January 10, 2011, 01:45:32 PM »
thanks for answering.

But I understood from Barbara Kahler at WPS Medicare that the add on codes 11045 or 97598 could not
be billed more than once a day?

oneround

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Re: Billing for Wound Care
« Reply #3 on: January 10, 2011, 01:54:52 PM »
Himph, I'd be courius as to what is driving that response as each code indicates for "each additional' and not per day.
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

cheryllesch

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Re: Billing for Wound Care
« Reply #4 on: January 12, 2011, 07:34:59 AM »

Barbara Kahler has now directed me to contact a professional coder as she only helps write the policies. Or call the phone number in the AMA Cpt code book.  Anyone have their number?

 But now I have another question:

I have a patient that has  wounds on both legs total sq cm   1121.75,      How do I bill this one?  Dr states to use 97597-98 codes.
 
Rt leg  27.5x27x.3
Lt leg  20.5x18.5x3

Thanks

cheryllesch

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Re: Billing for Wound Care
« Reply #5 on: January 13, 2011, 11:55:49 AM »
Hi Another question,

One of my doctors is coding as 11041 and 11040,
The wounds are   

3.7x3x.2   lt buttock         5.5x1.5x.15     Total 19.35 cm


Since I wouldn't  bill the 41 or 40  anymore,  would I bill this as 97597 and 97598?

I would not want to over or under bill this. Thanks

oneround

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Re: Billing for Wound Care
« Reply #6 on: January 13, 2011, 03:15:37 PM »
You are going to need to refer to the dictation.   .  I am going to refer you to pull your Meducare LCD on wound care as you really need to review the notes for proper code selection.  Wound Care has been and continues to be a target for the OIG.  it has not been induicated wether the procedure is selective or non-selective debridement techniques but judging by the code set it appears your indication the procedure is selective.  In which case with ONLY the information below codes are correct.

AGAIN, you truely need to review the chart to review exactly what the provider did and consult with your inhouse coders.

Hope this helps

 
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare