Wound care coding is a nuanced field of medical coding that demands an in-depth understanding of various wound types, healing stages, and treatment options. With the rise in chronic wounds, healthcare professionals must be adept at wound care coding to ensure accurate and timely reimbursement. Here are three detailed tips for managing wound care coding and billing:
Tip 1: Identify the wound type & stage of wound healing
There are four main types of wounds: acute, chronic, surgical, and traumatic. Acute wounds result from sudden injuries like cuts or burns, while chronic wounds, such as pressure ulcers, venous stasis ulcers, and diabetic foot ulcers, take longer to heal. Surgical wounds are incisions made during operations; traumatic wounds stem from accidents or injuries. Proper identification of the wound type is crucial for accurate coding.
Tip 2: Use relevant wound care billing codes and modifiers
Using the correct codes and modifiers is essential for proper reimbursement. Here are the top CPT codes for wound care billing.
97597: Debridement (first 20 sq cm or less)
+97598: Additional 20 sq cm debridement
97602: Non-selective debridement (per session)
97605: Negative pressure wound therapy (≤ 50 sq cm)
97606: Negative pressure wound therapy (> 50 sq cm)
HCPCS Codes for Wound Care
A6222: Gauze, sterile, ≤ 16 sq in
A6223: Gauze, sterile, > 16 sq in ≤ 48 sq in
A6234: Hydrocolloid dressing, sterile, ≤ 16 sq in
A6235: Hydrocolloid dressing, sterile, > 16 sq in ≤ 48 sq in
Modifiers for Wound Care
-59: Distinct procedural service
-LT: Left side
-RT: Right side
Tip 3: Use a’Wound Care Checklist’ for accurate coding and billing
The following checklist will help your practice minimize wound care claim denials.
- Documentation Description
- Documentation is for the correct beneficiary.
- Documentation is for the correct date of service.
- Documentation contains a valid and legible signature of the MD or DO performing the service.
- Mandatory Submissions
- Submit an Advanced Beneficiary Notice (ABN) if issued.
- Signed physician order for wound care/treatment.
- Patient History & Physical (H&P)
- Initial wound description, location, and measurements.
- Response to prior treatment, if applicable.
- Identification of wound location, size, depth, and stage supported by a drawing or photograph of the wound.
- Clinical Documentation
- Diagnosis or symptoms to justify services.
- Current progress notes include measurable signs of healing, causes of delayed wound healing, or modifications to the treatment plan.
- Documentation of the character of the wound (including dimensions, description of necrotic material present, description of tissue removed, degree of epithelialization, etc.) before and after debridement.
- Operative/Procedure Notes
- Note for the debridement services, including a description of tissue debrided, instrumentation used, and pre-and post-wound measurements.
- Plan of Care (POC)
- Containing treatment goals and physician follow-up.
- Additional Reports
- Consult reports, as applicable.
- Reports of all testing/services billed.
To conclude, ensure you thoroughly document all services in the patient’s medical record, including date, time, and details, to ensure accurate coding and billing. Use modifiers only when necessary to reflect changes in the service or procedure provided. Additionally, familiarize yourself with the payer’s reimbursement policies, including preauthorization requirements, claim submission deadlines, and billing procedures.
We recommend that you read these CMS guidelines on wound care billing and regularly review updates from credible sources like CMS and the AMA to stay current with coding guidelines and regulations.
Improving wound care billing outcomes requires expertise, attention to detail, and current knowledge of coding guidelines. PracticeForces offers fully HIPAA-compliant wound billing services. With over two decades of experience delivering cutting-edge billing solutions, our professional coders and billers will ensure at least a 20% improvement in your practice revenues within months. Don’t hesitate to contact us to learn more about our wound care billing services.
