Wiki Billing G0463 together with 11042 during a wound clinic visit vs only billing 11042

[xpamd1@hotmail.com]

Hi I work in a hospital based outpatient wound clinic. For the facility charges can one bill G0463 together with 11042 for a wound care visit; or should the facility only bill the procedure code 11042 (subQ debridement). The pt is only there for the wound no unrelated service but the wound. Appreciate the input.

 

[brleksbill]

First thing that comes to mind is procedure only. It sounds like the appointment was only for a wound care only. While yes a room was used, in my experience the G0463 is used on the facility side when an E&M is performed.

 

[rwiggins]

I have coded for our Wound Care center for 5 years. We bill the G0463 in the above case when the insurance is billed on a UB and 1500. Commercial insurances do not get billed that way.

 

[Pam Warren]

If this is provider-based billing for federal payers, you would report the procedure on both the 1500 and the UB. G0463 is the E&M equivalent on the facility side. If you did just the procedure on the professional side, you bill just the procedure on the facility side.