cberner
New
Hello, all. I am hoping this is the most relevant thread for this.
I am billing for a starting wound care company that delivers wound care in nursing facilities. We are having trouble with multiple insurances, including Medicare, denying line items for debridement of surgical wounds (using CPT 11042, 11045 and the like).
Some wounds only have the most accurate ICD-10 code of T81.31XD, Disruption of external operation (surgical) wound, not elsewhere classified, subsequent encounter. They deny as not medically necessary. The thing is, CMS and Codemap both list the initial encounter version of this code (T81.31XA) as a medically necessary code for debridement.
Most of the patients are followed on a week to week basis and are subsequent encounters. We cannot seem to find the combination to get these paid, but they need debriding all the time. (Tried aftercare codes with this code, tried an unspecified open wound anatomical site code along with it) Has anyone else encountered this?
Thank you!!
I am billing for a starting wound care company that delivers wound care in nursing facilities. We are having trouble with multiple insurances, including Medicare, denying line items for debridement of surgical wounds (using CPT 11042, 11045 and the like).
Some wounds only have the most accurate ICD-10 code of T81.31XD, Disruption of external operation (surgical) wound, not elsewhere classified, subsequent encounter. They deny as not medically necessary. The thing is, CMS and Codemap both list the initial encounter version of this code (T81.31XA) as a medically necessary code for debridement.
Most of the patients are followed on a week to week basis and are subsequent encounters. We cannot seem to find the combination to get these paid, but they need debriding all the time. (Tried aftercare codes with this code, tried an unspecified open wound anatomical site code along with it) Has anyone else encountered this?
Thank you!!