Expert Wound care medical billing services can improve your practice revenue

August 19, 2016

Expert Wound care medical billing services can improve your practice revenue

A large percentage of reimbursements for a healthcare facility comes from wound care. Hence, apart from overcoming the challenges, coders need to especially review the documentation, perform precise checking of services offered to the patient, and the billing of corresponding treatments (separate or packaged). 'Wound care' or ' wound management' includes controlling of co-morbid conditions, complications, nutritional issues, chronic illnesses and/or any other procedures which are directly/indirectly related to the wound.

Expert wound care billing requires the biller to review the patient's medical record thoroughly which should include wound dimensions, procedures conducted to handle the wound, first visit and follow up details, photographs of the wound and the details of the wound's inflammation/reduction, if the wound required extensive therapy along with other chronic diseases such as diabetes, ulcers etc.

There are couple of issues that need expert billers for obtaining accurate reimbursements.

  1. Medicare does not pay for dressing changes. An E/M service (billable evaluation and management) and another procedure (such as dressing or debridement) cannot be paid for separately unless there is a separate identifiable issue with the patient.
  2. Do not use modifier 25 unnecessarily; hyperbaric oxygen used without physician orders or hyperbaric treatments with inapt units can lead to claim denials.
  3. Ensure there are no incorrect/missing wound dimensions in the report.
  4. Be aware of puzzling selective/ nonselective debridement along with using different set of codes for documenting and reimbursing debridement.
  5. Coding must be done for the deepest layer for debridement than multiple layers (bone and muscle debridement cannot be billed for the same site).
  6. Do not code for E/M levels where not required (e.g. G0463 for Medicare specific cases).
  7. In cases of reassessment/reevaluation at follow-up and dressing has been changed, reimbursements are included as part of another service (e.g. cleansing of wound). And in case of an alteration in treatment, it is reimbursed if billed separately with an E/M code and the procedure code.
  8. Understand the basics and maintain accurate documentation required for billing and coding.
  9. Ensure that the center is protected from RAC recovery audit contractor) review auditors.
  10. Maintain a relationship with the business office to know the denials occurred and how to prevent them in future.
  11. Verify insurance on a monthly basis apart from verifying it before the first visit. Also, find out if prior authorization is required for a visit/procedure.
  12. Communication must be clear at all levels; awareness of latest rules by including regular training programs.
  13. Review the revenue cycle process (along with reviewing documentation, signatures, missing elements etc.)
  14. Analyze the billing and coding performance (are the claims reflecting services that were performed, what the payments are coming in etc.).
  15. The CPT states, "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)."

Accurate documentation is extremely crucial for obtaining apt reimbursements. And the aforementioned pointers will aid in financial success of the healthcare facility.


Category : Best Billing and Coding Practices