Wiki post op debridements

[solocoder]

Good morning podiatry coders. Hoping to get some of your great advice today.
Do anyone else's doctors do debridements of ulcers "at the incision", on their diabetic patients following surgeries such as amputations? To me, this sounds like it's either post op care, or a complication. I have had no luck so far getting the docs to clarify that for me. They don't seem to understand what I am getting at. Here's an example:
Patient presents to the clinic today, he is s/p amputation of the right third toe with a small remaining ulceration...There is a small, superficial ulceration noted at the central aspect of the incision...

Would debridement of that ulcer be billable?

Incidentally, there was no mention in the surgery note of possible "staged" debridements being needed.

Any opinions are greatly appreciated!

 

[PLAIDMAN]

Good morning podiatry coders. Hoping to get some of your great advice today.
Do anyone else's doctors do debridements of ulcers "at the incision", on their diabetic patients following surgeries such as amputations? To me, this sounds like it's either post op care, or a complication. I have had no luck so far getting the docs to clarify that for me. They don't seem to understand what I am getting at. Here's an example:
Patient presents to the clinic today, he is s/p amputation of the right third toe with a small remaining ulceration...There is a small, superficial ulceration noted at the central aspect of the incision...

Would debridement of that ulcer be billable?

Incidentally, there was no mention in the surgery note of possible "staged" debridements being needed.

Any opinions are greatly appreciated!

my docs do debride in post-op, but, they do not bill. "Typical post-op care" is included in the global, this includes pain management, wound care...this is per cms,aaos,cpt....the words "remaining" and "central aspect incision" make me think it is part of the surgical wound still.

what mod do you use? are you sure they want you to bill for it ?

 

[solocoder]

The doctors enter the charge for the debridement themselves, so yes, they expect me to bill for it. They have been using a 58 modifier for "therapy following a surgical procedure", which is one of the uses for 58 listed in the CPT book. But recently I have heard the opinion from some that these debridements probaby do not qualify as "therapy".
Still not sure if I need to put the kibosh on them.

 

[PLAIDMAN]

The doctors enter the charge for the debridement themselves, so yes, they expect me to bill for it. They have been using a 58 modifier for "therapy following a surgical procedure", which is one of the uses for 58 listed in the CPT book. But recently I have heard the opinion from some that these debridements probaby do not qualify as "therapy".
Still not sure if I need to put the kibosh on them.

If they are putting 58 on it, then, to me, they are telling you it IS part of the surgical wound......and wound care is included in global.

At the very least I would ask for clearer documentation as to why this surgical wound requires more than the "typical" PO care.

do you happen to know if any of these are even getting paid ?

 

[solocoder]

Yes, they do get paid. But I wonder if the payors think the 58 is indicating "staged" procedure. I have been working with them on adding the required documentation to their surgeries to supported "staged". I'm fairly sure that is the situation, but just not documented properly.
Haven't been able to find any clarification on the whole "therapy following a sugical procedure" bit.