Wiki E/M for Wound Care

[clbarry8033]

There has been a huge controversy at our wound care center about when doctors can and cannot bill for an E/M service when they do a debridement the same day. I had attented the online webinar for wound care coding and specifically asked the moderator if you could charge for an E/M the same day as a debridement, and they said "unless the provider addresses a condition or problem unrelated to the wound care, an E/M would be inappropriate." Therefore, I told my providers that unless it they provided a service completely seperate from the wound itself (i.e diarrhea, thrush, URI), that one could not be billed. They have made a pretty good case to me about charging one when osteomyelitis is present or when pain meds and/or antibiotics are given, but these are all, in my opinion, considered related to the wound itself.

Anybody have any opinions or definitive facts about these situations?

Can you charge for an E/M in those cases?

I was hoping fom some input from auditors, but any help at all would be greatly appreciated!

 

[CatchTheWind]

Technically, as long as a you provide a service that is not included in the work of the debridement code, you can bill an E/M, even for the same problem. The Medicare Claims Processing Manual (Rev. 2714, 05-24-13), Chapter 12, section 30.6.6(b) states: ?Carriers pay for an E/M service provided on the day of a procedure with a global fee period if the physician indicates that the service is for a significant, separately identifiable E/M service that is above and beyond the usual pre- and post-operative work of the procedure. Different diagnoses are not required for reporting the E/M service on the same date as the procedure or other service."

Good luck, however, arguing this to the payers! We are constantly fighting them even when the E/M is entirely unrelated!

 

[Pam Warren]

And the CCI edits say this:

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an
E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is "new" to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI does contain some edits based on these principles, but the Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits. Neither the NCCI nor Carriers (A/B MACs processing practitioner service claims) have all possible edits based on these principles.