Understanding Chronic Wounds: Definitions, Types, and Coding

First, we will review CMS’s definition of a chronic wound or ulcer and then the type of chronic wounds/ulcers and finally, their etiologies. Chronic wounds or ulcers are often difficult to treat and fully heal.

Secondly, the types of treatment available for chronic wounds/ulcers and their indications and limitations as defined in payer coverage or policy determinations. This will include the appropriate coding of individual treatments or multiple types of treatments, especially when occurring in the same session or on the same date of service. Modifiers pay a significant role as new requirements have recently been put in place.

Learning Objectives/Agenda

• Attendees will understand the difference between acute wounds and chronic ulcers as defined by CMS.
• Attendees will understand the different types of chronic non-healing ulcers and their etiologies. What causes an chronic non-healing ulcer?
• Attendees will understand and be able to apply the appropriate staging of pressure ulcers and their corresponding ICD-10-CM and CPT® codes. This will include the importance of the Wagner Grades.
• Attendees will be familiar with the different types of chronic wound treatment, both standard care and advanced treatment modalities.
• Attendees will understand and be able to apply the correct and appropriate codes for chronic ulcer treatments, including skin substitutes and hyperbaric oxygen therapy.

Why is this topic important?

There are few reliable resources for wound care coders. With the increasing diabetic population and aging population, we are seeing more and more patients with non-healing, chronic ulcers. This is even more timely and important. The increase in diabetes in the younger population also impacts this unrecognized specialty.

Who would benefit from this topic?

• Practice and clinic managers
• Coders, billers, and auditors
• Physicians and non-physician providers
• Practice and clinic nurses and supporting staff
• Chargemaster personnel
• Materials management personnel

What’s the presenter's background/expertise on this topic?

Linda has over 18 years offering wound care clinic and practice consulting and management. First as a consultant in wound are clinic implementation and management and then in the area of bio-pharmaceutic wound care skin substitutes and finally in general consulting for both practices and facility auditing and training.

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