Billing Guidelines for Wound Care in 2022

Basics of Wound Care Active wound care procedures are performed to remove devitalized and/or necrotic tissue to promote healing. Debridement is the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed. These services are billed when an extensive cleaning of […]

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Coding Guidelines for Skin Substitute Grafts

Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. This proposed rule also suggested some changes for skin substitute […]

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Medicare Coverage for Wound Care

Medicare covers wound care for all beneficiaries, irrespective that it is carried out in an inpatient or outpatient setting. It can be expensive for patients. Few people may suffer from post-surgical lesions. Other patients may suffer from chronic fungal or viral wounds. Due to the prevalence of wounds with age, it’s simple to understand why […]

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Coding for Open Fracture Debridement

Basics of Open Fracture Debridement Debridement is used to remove foreign material or damaged, dead, or contaminated tissue from a surgical field, wound, or injury. Debridement is used to promote healthy healing of damaged skin, tissue, muscle, or bone. The debridement of small amounts of devitalized or granulation tissue during a surgical procedure is typically […]

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How to code correctly for laceration repairs?

Answering a few questions will help you code correctly for laceration repairs (such as staples, sutures, or similar closure materials): Was the repair limited to the epidermis, dermis, and subcutaneous tissue, or did you need to probe more deeply? Use simple repair codes for superficial wounds (epidermis and dermis) that need only a single-layer closure. […]

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Identifying the Place of Service (POS) for Outpatient Wound Center

The Centers for Medicare and Medicaid Services (CMS) issued requirements for provider-based departments and entities as part of the final rule that implemented the Prospective Payment System for Outpatient Hospital Services (OPPS). From the payment perspective, “provider-based” means the entity is considered part of the hospital, and services furnished within that entity may be billed […]

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Considering Wound Care Compliance for Getting Paid on Time

All hospital staff members working in the wound center provide services under the direct supervision of an advanced practitioner (AP) (I.e. physician, podiatrist, or nurse practitioner). The practitioner can be employed by the hospital or in private practice. There have been cases in which providers’ alleged failures to satisfy provider-based criteria have given rise to […]

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Top 7 Challenges with Wound Care Medical Coding

Medical necessity denials traditionally focus on high-dollar MS-DRGs, such as those for hip and knee replacements; other MS-DRGs may also soon become targets. We have identified some of the challenges in Wound Care Medical Coding. Healthcare providers are likely to perform accurate medical coding under ICD-10 and that is when having an outsourcing medical billing coding […]

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Top 5 Questions Regarding Outpatient Reimbursement for Wound Care

Do outpatient reimbursement for Wound Care challenges frustrate you a lot? Medicare reimbursement regulations that are currently impacting wound care practices. Wound care professionals still have to follow the coding, payment, and coverage regulations for submitting claims to traditional Medicare. Issues in Outpatient Reimbursement for Wound Care: Q. 1: Why it is crucial to know […]

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Wound Care Billing Guidelines 2019

Not only is wound coding and documentation is a daunting task, but also attracts intense inspection from auditors, with severe financial penalties for mistakes. And it’s only gotten more challenging with the new ICD-10 changes. What is included in the wound care billing guidelines 2019? An infected surgical wound, T81.4xxA, is among those 51 codes […]

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