Wiki Wound Clinic billing with debridments

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kstults

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One of my surgeons spends half of his time at our local hospital's wound clinic. He does lots of debridements and has been told by the WC company not to charge an E&M along with debridement (he uses modifier 25). He disagrees with them as he counsels the patients on wound care etc along with debridement. I was hoping to get some advice from someone who has experience in a wound clinic setting. He unfortunatley has been told that RAC audits are headed their way (we are in Oregon). I would like to put his mind at ease that he is doing it the correct or why he needs to change.
Thank you
 
Procedure includes basic E/M

Every procedure includes some basic E/M. If the patient is being scheduled for wound care, including debridement or dressing changes, then the fee for the procedure already includes the evaluation of the patient.

It would be inappropriate to code for an E/M visit separately for these routine evals accompanying a scheduled procedure.

On the other hand, if the patient presents for wound treatment and also complains about a separate issue that requires evaluation & management, by all means code the E/M and append the -25 modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
Along this topic is a question I have with debridement codes as well as application of una boot. Can an MA(medical assistant) provide such services? The MA at my clinic does all una boot applications and the doctor cosigns the note. This doesn't sit well with me but now question who can perform what per CPT guidelines. For example, MA can give vaccines and injections-where is the line drawn for CPT codes that must be performed by an MD, NP/PA vs MA(if there is one)?
 
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