Wiki Wound Care

[Slrex]

I have a wound care question, I work with a wound care provider twice a week, he has always included a 99214(or applicable OV code) with his wound care codes, he has done wound care for a long time, he is now being told that after the first visit with the patient the only code is the debridement code with of course supplies, what is the rule on this? Thanks in advance for information.

 

[thomas7331]

The rules for billing an E&M service on the same day as wound care are the same as for E&M with any other procedure - the E&M and a modifier 25 must be supported by documentation that the E&M code represents a "significant, separately identifiable" service that is "beyond the usual pre- and post-operative care associated with the procedure".

The documentation for each visit would need to be evaluated on its own merits to know whether or not a 99214 was supported. But if the documentation shows that the only E&M service at the encounter was the related to the would care service and there were no changes to the treatment plan or management of other issues unrelated to the wound, then the modifier is likely not supported and an office visit code would not be appropriate.

 

[Orthocoderpgu]

Another thing to keep in mind is that every surgical code, no matter how small, has a built in E/M as well. If the patient has already been examined, the patient is returning for debridement every week can you justify an E/M for just looking at the wound knowing that your going to perform debridement again? I'm not saying you can't, I am asking can you support an E/M with medical necessity?