How To Be Careful About CPT Coding And Modifiers While Working On Wound Care?
The
misuse of CPT coding and billing modifiers is widespread and frequently done in
the case of wound care practices. This mistake can even make big holes in your
pocket once the inaccurately used medical billing modifiers are traced by the
insurance company or the third-party payers on a claim. Perhaps you can be
expected to return the insured money as well that insurance or third-party
payers paid you.
Disappointingly,
misused wound care billing modifiers may also trigger an audit
that can cost your practice hefty fines. In fact, such audit fines can go up to
as high as $10,000 for each mistakenly used modifier on a claim. That’s why an
in-depth understanding of codes for wound care services and other documentation
requirements is crucial for ensuring accurate reporting. Another easy way out
is to outsource wound care medical billing services to
an experienced company.
No
matter whether you outsource wound care billing services or
hire an in-house team, active wound care management involves the following CPT
Codes:
CPT Codes:
Wounds
involving subcutaneous tissue
11042: Used for debridement,
subcutaneous tissue (including dermis and epidermis, if performed) for first 20
sq cm or less.
+11045: for each additional 20 sq
cm, or part of.
Wounds
involving muscle and/or fascia
11043: Used for debridement,
muscle, and/or fascia (including dermis and epidermis and subcutaneous tissue,
if performed) for the first 20 sq cm or less.
+11046: for each additional 20 sq
cm, or part of.
Wounds involving bone
11044: Used for debridement, bone
(including dermis and epidermis and subcutaneous tissue, muscle, and/or fascia,
if performed) for first 20 sq cm or less.
+11047: for each additional 20 sq
cm, or part of.
Evaluation/Re-assessment
is Included in Wound Care Service
- Generally,
it is considered to be wrong to report an E/M service in addition to a
wound care service (e.g., debridement, suture removal, application of an
Unna’s boot, etc.).
- E/M
can be reported additionally if the physician performs and documents a
significant and identifiable service separately during the wound care
encounter. Also, the E/M service must be distinct from the scheduled visit
for the same wound care and require medical evaluation and treatment for
the same wound care.
- According
to modifier 25, the E/M Service can be reported separately if the
evaluation and management service is done by the same physician or any
other trained health care professional on the exact same day of the
procedure or any other service.
Documentation
Essentials
- The
narration of the wound includes size along with length, width, depth, and
total square cm. the appearance, undermining, drainage, character,
infection, presence of edema, the disease-causing underlying complications
on healing the wound, and other problems related to it.
- Description
of the things used in the debridement procedure, for example, scalpel,
curette, scissors, nippers, etc.
- A
complete narration of which deepest layer of the tissue was removed in the
debridement process, for example, devitalized dermis and/or epidermis,
fibrin, subcutaneous tissue, biofilm, exudate, muscle, and/or bone.
- Post-op
care instruction provided on the progress of the wound with the
specification of the dressing applied and follow-up notes in brief, future
process plans.
- Complete
narration on wound improvement or any measurable changes like
inflammation, pain, swelling, necrotic tissue slough, wound improvement or
declination, wound dimension changes, etc.
- A
complete and precise description of the tissue that has been cut away in
the chart notes.
- A
complete description of the steps to address the new condition that might
include oral antibiotics, further testing, consultation request for
vascular interventions, a biopsy of the wound, and podiatric consultation
for off-loading or bracing.
You must watch
out for these coding errors!
According
to a recent Medscape article, the most common issues that can initiate claim
denials for wound care billing services are:
- Confusion
between whether there is a separately billable service or not, i.e.,
incorrect use of modifier 25.
- In
the case of wound dimensions for the debrided area, not considering the
add-on codes.
- Absence
of or poorly documented wound dimensions
- Medical billing service providers for
wound care have
to be very careful about puzzling between selective and nonselective
debridement.
- Use
coding for debridement of multiple layers per site instead of the deepest
layer of debridement. As an example, bone and muscle debridement cannot be
coded together for the same site.
- Coding
for change of dressing of wounds separately from an E/M service.
The
financial health of any wound care practice depends on revenue cycle management
and complete wound care billing
solutions.
It’s essential to be careful while using modifiers correctly, precisely
recording patient records and healthcare provider’s notes, and certifying that
the claims are definitely not under or over-coded. This is precisely why
you should outsource wound care medical billing services.
24/7
Medical Billing Services experts know all about the ins and outs of insurance
and third-party payers, acknowledging the prevention of denials and rejections
in the first place. In fact, this is the best “cleaning solution” of receiving
the revenue quicker.
About 24/7 Medical Billing Services:
We are a medical billing company that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7 Medical Billing Services
Tel: +1 888-502-0537
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