Wiki Wound Debridement - 97597/8 vs. E/M Code?

[ljmcnamara3]

Hi everyone! Just looking for some feedback - so I am thanking you in advance for your assistance!

Scenario - Patient seen at SNF and rather than report the Selective Wound Debridement code(s) 97597/97598 - Provider wonders if she can rather report a Subsequent Follow up visit such as 99307 or 99308.

Provider is performing the key components of an E/M (Hx, Ex, MDM) and is determining that selective debridement is approrpiate and does so. However - 97597/8 not being paid by Medicare Part B.

I've never come across this before - any input would be greatly appreciated!

Best,
Laura J McNamara, CPC, CPMA, CEMC

 

[espressoguy]

Why is Medicare denying the debridement?

What is the diagnosis?

 

[Pam Warren]

Medicare is denying the debridement because 97597 and 97598 done at a SNF falls under the consolidated billing rules. You'll need to be reimbursed by the SNF, because they are required to provide those services to patients as part of their global payment from CMS. And if they have to get an outside provider to do them, they have to pay the outside provider. You'll need a billing arrangement with them. If they're unaware of this regulatory guidance, you'll have to show them the light....we had a heck of a time with our local SNFs and NHs, but when we showed them CMS's guidance, there was nothing they could do.

You'll have to peak to the SNF about this, and reference 42CFR IV 424.20 and Med Learn Matters article SE 1308.

E&M done with a debridement should be significant and separately identifiable. Tough to do if the reason for the visit to the SNF is specifically for the debridement. Good luck.