When providers need outpatient wound care billing, CPT codes 11043, 11046, and 11044, 11047 may only be billed in place of service inpatient hospital, outpatient hospital, or ambulatory surgical center (ASC).
Outpatient wound care is often considered early discharge of patients from the acute care setting to the home care setting and surgical wound care will be delivered by patients, family members, and home health care providers instead of the hospital nurse in a traditional in-patient setting.
Currently, wound healing is an evolving specialty with wound care practitioners facing many challenges, including rising healthcare costs and difficulties in ensuring access to and quality of care and all these challenges can easily be addressed by the outpatient wound care model by streamlining safe, cost-effective, and easily accessible care for patients.
Lowers Overall Healthcare Cost
An outpatient wound healing center lowers overall healthcare costs as it requires less overhead expenses which reduces costs dramatically. By centralizing all wound care services under one roof, without the size and space required by a hospital, the costs more accurately reflect the services and procedures for which the patient is paying.
Since the outpatient facility is generally smaller, the staff is reduced and the result is more cost-effective wound treatment for the patient. Moreover, in an outpatient center, it is expected that one expert physician oversees all treatment and the patient receives seamless care at each visit, thereby ensuring complete continuity of care.
However, it is not an easy task, providers need to be cautious while transitioning patients to outpatient wound care facilities. Let’s understand in more detail:
Important factors for transitioning from inpatient to outpatient wound care
You need to consider various factors like overall health, access to services, severity, and complexity of the wound, and equipment availability while transitioning a patient from inpatient to outpatient care and during care transition treatment you should use modalities to maintain continuous care.
For outpatient wound care, NPWT use was recommended for the removal of infectious materials and exudate management. Moreover, dressings like The ORC/C/silver-ORC may be used to help manage exudate and promote granulation tissue development and moist wound healing.
Now you have equipped with outpatient wound care information, now you need to be aware of its billing. Let’s discuss in more detail:
Outpatient Wound Care Billing
When patients are seen by a QHP (Qualified Healthcare professionals) in an HOPD, the patients and Medicare receive two bills: one from the HOPD and one from the QHP while when patients are seen by a QHP in his or her office, the patients and Medicare only receive one bill.
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report service.
Code |
DESCRIPTION |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 018x | Hospital – Swing Beds |
| 022x | Skilled Nursing – Inpatient (Medicare Part B only) |
| 023x | Skilled Nursing – Outpatient |
| 071x | Clinic – Rural Health |
| 073x | Clinic – Freestanding |
| 074x | Clinic – Outpatient Rehabilitation Facility (ORF) |
| 075x | Clinic – Comprehensive Outpatient Rehabilitation Facility (CORF) |
It is observed that MACs may update LCDs as often as they deem necessary hence wound care professionals should assign someone to review LCDs every month. When LCDs are revised, all wound care professionals should read them carefully.
The trend in health care seems to be moving away from hospital-based wound care to the more centralized outpatient wound care models that have benefited patients in the areas of intravenous antibiotics and now in wound management.
You can outsource your wound care billing, we can help you to increase your overall collection. We are a HIPAA-compliant leading medical billing company.
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FAQs:
Q. When can CPT codes 11043, 11046, 11044, and 11047 be used?
A: These CPT codes should only be used for inpatient hospital, outpatient hospital, or ambulatory surgical center (ASC) settings, not for outpatient wound care.
Q. What are the benefits of outpatient wound care compared to inpatient settings?
A: Outpatient wound care reduces overall healthcare costs by lowering overhead expenses and providing more cost-effective treatment with centralized services, smaller staff, and expert oversight.
Q. What factors should be considered when transitioning patients from inpatient to outpatient wound care?
A: Providers should consider the patient’s overall health, access to services, severity and complexity of the wound, and availability of necessary equipment to ensure a smooth transition and continuous care.
Q. How is billing handled for outpatient wound care in a hospital outpatient department (HOPD) versus a private office?
A: In a HOPD, patients and Medicare receive two bills—one from the HOPD and one from the qualified healthcare professional (QHP). In a private office, only one bill is issued.
Q. Why is it important to regularly review Local Coverage Determinations (LCDs)?
A. LCDs may be updated frequently by Medicare Administrative Contractors (MACs). Regular review ensures that wound care professionals stay informed about the latest billing guidelines and coding requirements.
