Wiki Out Pt Wound Care Coding for a Doctor

[Linda77]

Hello everyone,
I have a new Dr. that would like to start coding when she does wound care on her patients that are registered in the out patient wound care center at the PT department.
She would actually be doing the wound care but the issue is that I am sure the facility would fight me on the codes since these codes are normally charged by the PT department.
Would it be best for her to just charge an E/M? Or just hash it out with the PT department? Another question I was under the impression that some wound care codes are not for
Dr.uses.?? Thanks for the help!

 

[thomas7331]

The facility cannot fight you on this - facility fees and professional fees are separate things and there is no overlap. The facility cannot bill for what your provider does and your provider cannot bill for services performed by the hospital employees. Your provider should bill for what she personally does, with the appropriate place of service code, and will be reimbursed for the professional fee for those services - you should report the code that best represents those services and not change to an E&M code just for payment purposes. Accurate reporting by your provider will not negatively impact the hospital's revenue and the facility will continue to charge their own fee for the costs associated with the use of the facility and the services performed by their employees.

Most wound care codes have a professional fee associated with them that doctors can use - there a just a few, such as 97602, which are not payable under the physician fee schedule. I'd recommend speaking with the wound center about possibly sharing with you some of their coding resources, or alternatively you can likely find some articles or webinars on the particulars of wound care coding.

 

[Linda77]

Thanks