# Wound Care Center Billing



## kfrycpc (Jul 6, 2012)

Hi all, I've just begun billing for our new wound care center ("wc"),  and even though I've done alot to learn about it, I have a couple of questions.  First, I have an E/M code in addition to a WC CPT code, i.e. 97597.  So I have to use the "25" modifier on the E/M line correct?  Are there any other commonly used modifiers for wc billing?  Also, is the place of service Outpatient Hospital or Office?  I'm sorry if these questions seem simple but I just want to double check!  Thanks! Kellie


----------



## SallieF (Jul 6, 2012)

I use the modifier 25 quite a bit when posting charges for the WCC. You are correct to use 25 in this scenario and POS is OP. There are times if multiple procedures are performed I have had to use 51 or 59. I rely heavily on LCD's especially for HBO02 therapy (99183), 97597 and debridements .


----------



## kfrycpc (Jul 6, 2012)

SallieF said:


> I use the modifier 25 quite a bit when posting charges for the WCC. You are correct to use 25 in this scenario and POS is OP. There are times if multiple procedures are performed I have had to use 51 or 59. I rely heavily on LCD's especially for HBO02 therapy (99183), 97597 and debridements .



Thank you Sallie.  I have to learn the instances when 51 or 59 is used. Can you give an example? I was confused whether it should be OP or office.  LCDs? I should know this but what does that stand for?


----------



## mitchellde (Jul 6, 2012)

LCD stand for local coverage determination, 51 and 59 will depend on the specific scenario.  51 is not used by many carriers anymore so you will need to check, it only indicated that the procedures were performed in the same setting.  the 59 will depend on CCI edits, it is used when the second procure is not a component of the first which you can support with documentation due to separate site or separate incision or separate session.


----------



## SallieF (Jul 6, 2012)

Most insurance companies follow Medicare guidelines so I follow these closely and have not had a denial yet.
To find these go to: www.cms.gov/medicare-coverage-database/indexes. this should take you directly to a listing of all the LCD's.


----------



## mitchellde (Jul 6, 2012)

Just one word of caution here please do not use the LCD to determine the diagnosis, the diagnosis must come from your provider's documentation.  The LCD should be your guide to know when you will need an ABN.


----------

