Wiki Dressing change for a new patient

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tfrick2

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We had an interesting situation come up that I need help with.

How would you code for a new patient who was sent by his PCP to a hospital-owned wound care center for dressing changes? The patient was only seen by the nursing staff, not by a doctor, because there were no available appointments with the doctor at the time. There was no debridement done during the visit.

If this was an established patient, we would charge 99211, but since this was a new patient who didn't see a doctor, we're just not sure that 99201 is correct.

Thank you for your help!
Tracy, CPC, CPC-H
 
Since this is just a dressing change and there really wasn't any wound care done, it would typically be charged as a 99211 for the nurse visit for an established patient. That's why we're unsure of how to bill this one for the new patient.

Tracy, CPC, CPC-H
 
If you are billing for the facility then you should have have facility criteria to follow for the level of care. In the facility the E&M is not dependent on whether the patient is attended to by a physician but rather the resources expended by the facility so follow your facility criteria, In our facility for wound care that did not meet the criteria for the CPT codes we had points assigned for the size of the wound, the number of points then determined the level of E&M. Also it makes no difference if the patient is new or established for the facility charge. If you are talking about a physician charge then from what you have given there can be no charge.
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