Wiki Modifier -25 and Wound Clinics

[cwarnerjr]

Currently I am locked in an appeal cycle with our intermediary regarding the proper use of modifier -25. I cannot seem to get this specific question answered in any of the reference material. Here is the scenario:
A patient comes to the Wound Clinic for follow up and has multiple wounds. One or more of the wounds have a debridement performed, but not all of them. We have been charging the debridement charge(s) depending on the total area of the debrided wound(s) and an E&M charge for the care provided to the wounds that were not debrided (dressing change, compression applied, topical medications applied, etc.) and appending a -25 modifier. Our intermediary is pushing back stating the assessment is included with the debridement procedure. I agree that it would be if the only wounds being treated during the visit were the debrided wounds, but when the patient has other wounds that were not debrided and were attended to during that same visit, is that not considered "separately identifiable and unrelated to the decision to perform the debridement" and thus the E&M code and modifier -25 is appropriate? I have appealed to the QIC, but it has not ruled yet. Any thoughts?

 

[nickelclaw]

Only if it is a new wound from the reason for follow up. Just because not all wounds were debrided doesn't mean per say that you can bill the E/M.
Example: pt in for F/U of decubitus ulcers and new non pressure ulcer of heel then you could as long as the documentation is there to support that

To me the initial wound visit probably had all the multiple wounds stated; with this being a F/U if none of these are new then you may not bill the E/M.
Hope this makes sense

 

[cwarnerjr]

Thank you for your reply.