Wiki Debridements of venous stasis ulcers

Create Wiki
K

KSTONE

New
Messages
4
Location
Cary, NC
Best answers
0
:confused:
We perform several debridements on patients in the office for venous stasis ulcers. Some are very large in nature. For example the one that I am having trouble with has One on the right leg measuring 12cm x 18cm., left leg 13cm x 20cm. They both include sub q. So the debridement code would be 11042. However the new code now reads for the first 20sq cm. then use 11045 for each additional 20sq cm. In my calculations that is at least 476sq cm. That would be using the add on code several times. My question is "IS THAT THE CORRECT WAY TO CODE THIS?" It does not seem correct to me but I am at a lose if it is not. Would someone please help me.


Thank you
K Stone
 
I just recently submitted the new add on code with the unit amount changed to equal the square centimeters that were debrided. This was the only idea I had to report the size properly. Have not gotten anything back but this was very recent. Hope this helps.
 
Thank you very much for your input. I have not thought about changing the units. I will try that too and see what response I get back. Thanks again.
 
I code for wound care services and have used the new add on codes for all the levels of debridement and change the units to report the additional square cm debrided. Medicare is paying us correctly based on the units.

Susan Smith, CPC
 
I also code wound care and I have had a patient so far that had multiple debridements and we have used up to 70 units on the add-on code 11046. So far we have received one payment back from BCBS and they paid all the additional units!
Now Medicare is a different story. I am in TN and our MAC is Cahaba. After receiving several denials, we found out that the MUE for the new debridement codes are 1 and that this will be changed but not until April 1 at which time I was told we will have to refile all of our denials because they will not automatically reprocess these claims.

Does anyone know if we can bill 11042 and 11042-59 in a scenario like the one above since one wound is on the right leg and the other on the left?
Thanks!
 
11042 is used once then bill 11045 for the number of units for the total sq cm for all wounds at the same level (similiar to closure codes).

This is how I have been billing since January but my concern is redebridements, we do allot of wound care, multiple, large wounds and I feel AMA could have been clearer in those scenerios.
 
When you bill 11042, it is for the total sq cm of subcutanous tissue debrided, this includes if there were 2 or even 3 separate ulcers in different locations. You have to total the sq cm at the subcutaneous level of debridement. You can't use -59 modifier for different ulcer or location.
 
One wound multiple depths

How would this scenerio play out if it was one wound with multiple depths? total wound measures 100 cm wound but
60cm is only Subq the other 40cm is to muscle/fascia.
Would the codes be:
11042 for the first 20 cm of subq then
11045 x 2 for the additional 40 cm of Subq then
11043 for the first 20 cm of muscle facia and then
11046 for the additional 20 cm of Muscle.
OR do we just bill to depth which would be
11043 and 11046?

Thanks
 
when billing 2 different level for a visit use the 59 modifier

for example

11043
11042 59
11045
11045(units)

my question would be for the additional 45 would I need a modifier? we receive denials for the additonal add ons
 
Debridement

I bill them this way: Now that the MUE is corrected, you shouldn't have any problem with payment.

1. Add all the wounds of the same depth together
2. subtract the first 20 sq cm and pick your primary code from the wound depth
3. divide the rest of the area by 20 to figure out how many units of the add-on code to bill
4. Bill the add-on code x that quantity

so in your example-
11042 x 1(first 20 sq cm of subq)
11045 x 2(40sqcm/2)
11043 x 1 (first 20 sq cm of muscle depth)
11046x 1 (additiona 20 sq cm of muscle depth)

The primary codes are:
11042 sub q
11043 muscle
11044 bone

So you have to bill one of the above codes before you can bill their partner add-on code for the extra sq cm.
11042 -add on code is 11045
11043- add on code is 11046
11044 - add on code is 11047

On your hcfa, always bill
the primary code x1
the add on code x correct quantity (remaining area/20)
the primary code x 1
the add on code
So the system will find the code as the payment edits work through

Good luck!
 
MMAYCOCK:
Who is your MAC? I am in TN and we go through Cahaba. The denials we recieved on the add on codes were all refiled after April 1 and we are still getting denied. I checked and see that the MUE has been updated but it doesn't seem like their system is updated yet.
 
You must log in or register to reply here.
Top