Wiki 11055 with 97597

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sewilke

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I have been told that when paring (11055) and debridement (97597) are both done on the same wound, that only the paring is charged. I am coding for Wound Care, but I cannot find a resource anywhere that backs this up. Can anyone provide a link or additional information?

Thank you!
 
The codes can be billed together, but not for the same wound. With that said, which one to bill depends on the documentation. Either it's a callus or a wound, not both.

Here are some partial quotes from Dr Poggio and Bass from Codingline, great resource.
"I think we need to be careful with the terms we use. Essentially, every callous is in theory pre-ulcerative if left untreated. By the same logic is every curved nail pre-paronychial?
CPT 97597 states debridement of OPEN wound (eg fibrin, devitalized epidermis/dermis, exudate, debris, biofilm). Can you document these and similar findings in your chart? If not, then I would recommend using the callous debridement code CPT11055." "The safest answer to this question is the following: bill for what you did. I think if the ulcer is closed, as is stated in the question, then +97597, which requires an open wound, would not apply here. If truly a pre-ulcerative callus, then billing for 11055 is appropriate."
 
podcoder70 said:
The codes can be billed together, but not for the same wound. With that said, which one to bill depends on the documentation. Either it's a callus or a wound, not both.

Here are some partial quotes from Dr Poggio and Bass from Codingline, great resource.
"I think we need to be careful with the terms we use. Essentially, every callous is in theory pre-ulcerative if left untreated. By the same logic is every curved nail pre-paronychial?
CPT 97597 states debridement of OPEN wound (eg fibrin, devitalized epidermis/dermis, exudate, debris, biofilm). Can you document these and similar findings in your chart? If not, then I would recommend using the callous debridement code CPT11055." "The safest answer to this question is the following: bill for what you did. I think if the ulcer is closed, as is stated in the question, then +97597, which requires an open wound, would not apply here. If truly a pre-ulcerative callus, then billing for 11055 is appropriate."
Click to expand...

The provider is saying that the outer area of the wound is calloused and required paring, but that he debrided the remaining surface of the wound. Using the NCCI edits, would this mean I could add modifier 59 to the debridement? If not, and only one of the procedures is charged, which one would take precedence?
 
Good question, I would think the wound, however, make sure the provider has documented depth of debridement, measurements post debridement and what instruments he/she used for debridement. Also needs to note exudate/drainage. If the wound was debrided into and including subq tissue, it is now a 11042. You will need an ICD10 beginning with an L. If none of this has been documented, then it is a callus debridement.

11055 and 97597 can be billed together with 59 modifier on 97597 if for example there is a callus on right foot and wound on left foot.
 
podcoder70 said:
Good question, I would think the wound, however, make sure the provider has documented depth of debridement, measurements post debridement and what instruments he/she used for debridement. Also needs to note exudate/drainage. If the wound was debrided into and including subq tissue, it is now a 11042. You will need an ICD10 beginning with an L. If none of this has been documented, then it is a callus debridement.

11055 and 97597 can be billed together with 59 modifier on 97597 if for example there is a callus on right foot and wound on left foot.
Click to expand...
That makes perfect sense! It did not seem reasonable, to me at least, that the paring would take precedence over the debridement, when debridement is a more extensive service. Thanks so much for your help & feedback!
 
Good morning, I'm new to coding and I'm scheduled to take my exam in two weeks. Can some one help me on the NCCI edits. I was on CMS website and is looking for CCM 1 in reference to modifiers. & what edits is placed on certain codes...... Can you please point me in the right direction?
Thank you in advance!
 
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