Most healthcare practices lack in documenting the clinical substance required to support their claims, and most often fail to capture a physician’s clinical judgement and medical decision-making for carrying out the procedure. When it comes to wound care medical billing or external debridement, physicians are required to provide documentation during the course, but the necessity of documentation plays more than that if you look at their own payment. Therefore, without sufficient documentation, it is difficult to do medical coding for inpatients.
It is highly crucial to do wound care medical coding for the wound care providers by following the end-to-end ICD-10 guidelines. We would like to highlight some of the wound care challenges with medical coding and how it affects your medical billing.
Challenges with wound care medical coding
- Simply assigning a code for the respective procedure and expecting payments from the insurer do not work with wound care medical billing. The code alone does not translate to the coverage for the procedure, and it becomes vital to understand the rules under which you operate that code.
- Most practices may forget to provide the add-on codes for the actual code. For an instance, if removing a certain length of tissue at a certain depth, the insurer would look at the base code and the add-on code. But for another length of subcutaneous tissue, the insurer identifies the coding would be combination of two codes. These kinds of errors are seen common in wound care coding.
- When assigning a present on admission indicator for pressure ulcers, particularly, when the provider does not document the ulcer for many days even after the admission of inpatient, coders should be too cautious. At this point, coders should report an ulcer as present on admission, and it requires only adding up a simple query without any need for documentation.
- If you look at ICD-10-PCS, it shows exact variation between excisional and non-excisional debridement. The root operations excision and extraction indicate excisional debridement and non-excisional debridement, respectively, but it is not necessary for physicians to specify the word extraction. Anyhow if the documentation states that the tissue was pulled up and stripped away, instead of showing cut, it means that an extraction procedure was performed. This requires coders to be more specific in anatomic wound locations.
- Wound debridement, active wound care, and open fracture debridement coding are all different, and it requires a mere understanding for your in-house medical coders. Most often errors in wound care coding occur when skin grafting/replacement is involved.
- Another problem that causes billing delay in a wound care practice is delay by physicians in responding to documents. The general tendency of physicians is they do show some response only during their administrative hours. Therefore, to overcome this kind of delay, practices should consider automating physician queries and support in boosting revenue.
The wound care medical billing process involves several procedures and requires complete evaluation of the medical records of patients for the wound that should cover wound dimensions as well, and if patients have any chronic diseases and treatment for the same, list of procedures offered to treat the wound, follow-ups, firs visits, photographs of the wound and its progress, etc.
Having 24/7 Medical Billing Services as your medical billing partner can help you overcome all these challenges and streamline your wound care practice more extensively.