Medical Billing Forum

Billing => Billing => : cheryllesch January 20, 2011, 06:23:36 PM

: CPT Code changes for 2011 for debridement and wound care
: cheryllesch January 20, 2011, 06:23:36 PM

Hi,
My physicians do in home wound care.   The CPT codes for 11042  and 97597 and 97598  descriptions have changed for 2011.    I am now getting rejections from our carrier WPS Medicare stating that the
11042 debridements codes the code billed is inconsistent with the place of service.
Has anyone heard that "surgery" codes of 11042 can no longer be done in the place of service (home)?
Is it written anywhere that is easily accessible?   
I have read the wound care policies that WPS Medicare has and nowhere does it say that surgery cannot be done in place of service home.

Anyone in Detroit, Michigan area I can talk to?  Thanks

: Re: CPT Code changes for 2011 for debridement and wound care
: Michele January 22, 2011, 10:24:43 PM

I would recommend calling and asking a customer service rep to explain the denial and point you to the CMS website where it supports the denial.  I know of many providers doing in home wound care and have not heard of such rejections.  Sometimes another situation can cause the rejection to appear to be one thing when it really means another.  I would call for clarification.

Michele