Every wound care provider provide excellent care services to patients. But they face a lot of hurdles with wound care billing collection. Many providers do not have a proper billing process in place, and hence they are not able to collect significant amount of revenue. So, it is important to understand the challenges in the wound care billing for wound care providers to find the solutions for the same.
Wound care providers, billing and coding processes that require the in-house department to be constantly in front of them. From eligibility verification, billing, coding, account receivable for wound care administrators is an unbelievable challenge in numerous wound care facilities.
There is a confusion with billing and coding is that if there is a CPT code for a procedure, the insurance plan will have to pay it. It is not mandatory for insurance payers. Thought you have a code it is not mean that the coverage for the procedure will have incorporate in it, therefore, it becomes imperative to know the rules under which you must operate is a must.
There is one more common reason is not using the add-on codes properly while submitting claims. If physician removing over 20 sq cm of tissue at a certain depth, medical coders should use the base code and the add-on code. For example, if removing 28 sq cm of subcutaneous tissue, he notes the coding would be both 11042 and 11045. For debridement of muscle or fascia, coders report 11043 for the first 20 sq cm and 11046 for every additional 20 sq cm.
Selective debridement (CPT codes 97597-97598) is the removal of nonviable tissue. Unlike excisional debridement, the physician removes no living tissue in a selective debridement.
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.
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.
The wound care medical billing process includes numerous procedures and requires complete evaluation of the medical records of patients for the wound that should cover wound dimensions and chronic diseases (if patient has any) 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.
Contact us today to streamline your wound care practice revenue cycle management. Our medical billing manager will help you to overcome all wound care challenges.