Top Challenges with Wound Care Billing Services

Denials in healthcare usually focus on high-dollar procedures like hip and knee replacements, or other MS-DRGs may also come under this radar. With wound care medical billing and coding, we have identified so many challenges.

Proper documentation is necessary for clinical substances and processes especially when support medical necessity is involved. This doesn’t attract a clinician’s judgment and medical decision-making for performing the procedure. Physicians have been conditioned to document excisional debridement, but if we think about payment recovery for these practices, they need to do a lot more than just paperwork and documentation. To handle wound care medical coding for inpatients frequently lacks sufficient documentation.

It’s now more than important for wound care providers to make sure that they are coding to the accuracy and following all the ICD-10 guidelines. While it’s not so clear about the elimination of CMS was under this grace period, it might be some things that we are working on with ICD-10 that may not continue to be satisfactory.

Many times, a wound care center offers excellent patient care, and healing rates are high. But, when it comes to calculating revenue, clinical staff is left in the dark. While providing good patient care is necessary, a center that misses tracking its revenue may soon see its doors closed.

Wound care billing and coding are at the heart of every practice and are important for the survival of the center.

Here are some challenges we found with wound care billing and coding.

  • The most common error is wound care facilities don’t use the add-on codes properly. If removing over 20 cm2 of tissue at a particular depth, it’s important to use the base code and the add-on code. For instance, if removing 28 cm2 of subcutaneous tissue, the notes for the coding would be both 11042 and 11045.
  • It’s a common myth with coding and billing that if there is a code for a procedure or product, the insurance plan will pay it. This is not always the true cause. Having a code doesn’t always mean the coverage for the procedure, hence, it’s important to know the rules under which you must operate.
  • ICD-10-PCS differentiates between removable and non-removable debridement. The ICD-10-PCS root operations excision and extraction indicate excisional debridement and non-excisional debridement, sequentially. This doesn’t suggest that physicians need to use the term extraction, but if paperwork shows that the tissue was pulled or stripped away, rather than cut, the debridement is a removal. ICD-10 will need coders to note laterality and more specific anatomic wound locations.
  • Coders need to be aware of assigning a present on admission (POA) indicator for pressure ulcers, particularly when the healthcare service provider does not note down the ulcer until many days after inpatient admission. Coders need to report an ulcer as POA in case of signs or symptoms are POA. A query may be needed without documentation of signs or symptoms.
  • There have been arguments, and discussions between what’s recognized to be a “wound” versus an “ulcer.” Sometimes, ICD-10 is similar to its language, and this is an ideal situation. Be aware of the ICD-10 semantic, that medical staff takes for granted. While many service providers may replace the terms “ulcer” and “wound” as if they are replacements, they are no different when it comes to ICD-10 medical coding.
  • Practitioners reply to the documents during their administrative hours. Because standard physicians’ query stays in medical coding and billing and doesn’t have a great response rate from physicians, clinicians should consider automated physician queries.
  • Understanding the difference between open fracture debridement, wound debridement, and active wound care coding. Also, there are a few errors when coding correctly during skin grafting/replacement is involved.

The wound care billing and coding are all about a thorough evaluation of the patient’s medical record for the wound, which also includes wound dimensions, chronic diseases which includes chronic ulcers, diabetes, quadriplegia, etc. processes offered to manage the wound, follow-up, initial visit, photographs of the wound, and wound progress. To have 24/7 Medical Billing Services as your wound care medical billing and coding partner can revolutionize your practice by overcoming the above-mentioned challenges.

Read more: How To Be Careful About CPT Coding And Modifiers While Working On Wound Care?

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