Outpatient Wound Care Billing

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Outpatient Wound Care Billing
When providers need outpatient wound care
billing, CPT codes 11043, 11046, and 11044, 11047
may only be billed in place of service inpatient
hospital, outpatient hospital, or ambulatory
surgical center (ASC). Outpatient wound care is
often considered early discharge of patients from
the acute care setting to the home care setting
and surgical wound care will be delivered by
patients, family members, and home health care
providers instead of the hospital nurse in a
traditional in-patient setting. Currently, wound
healing is an evolving specialty with wound care
practitioners facing many challenges, including
rising healthcare costs and difficulties in
ensuring access to and quality of care and all
these challenges can easily be addressed by the
outpatient wound care model by streamlining safe,
cost-effective, and easily accessible care for
patients. Lowers Overall Healthcare Cost An
outpatient wound healing center lowers overall
healthcare costs as it requires less overhead
expenses which reduces costs dramatically. By
centralizing all wound care services under one
roof, without the size and space required by a
hospital, the costs more accurately reflect the
services and procedures for which the patient is
paying.
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Outpatient Wound Care Billing
Since the outpatient facility is generally
smaller, the staff is reduced and the result is
more cost-effective wound treatment for the
patient. Moreover, in an outpatient center, it is
expected that one expert physician oversees all
treatment and the patient receives seamless care
at each visit, thereby ensuring complete
continuity of care. However, it is not an easy
task, providers need to be cautious while
transitioning patients to outpatient wound care
facilities. Lets understand in more
detail Important factors for transitioning from
inpatient to outpatient wound care
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Outpatient Wound Care Billing
You need to consider various factors like overall
health, access to services, severity, and
complexity of the wound, and equipment
availability while transitioning a patient from
inpatient to outpatient care and during care
transition treatment you should use modalities to
maintain continuous care. For outpatient wound
care, NPWT use was recommended for the removal of
infectious materials and exudate management.
Moreover, dressings like The ORC/C/silver-ORC may
be used to help manage exudate and promote
granulation tissue development and moist wound
healing. Now you have equipped with outpatient
wound care information, now you need to be aware
of its billing. Lets discuss in more
detail Outpatient Wound Care Billing When
patients are seen by a QHP (Qualified Healthcare
professionals) in an HOPD, the patients and
Medicare receive two bills one from the HOPD and
one from the QHP while when patients are seen by
a QHP in his or her office, the patients and
Medicare only receive one bill. Bill Type Codes
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Outpatient Wound Care Billing
Contractors may specify Bill Types to help
providers identify those Bill Types typically
used to report service.
Code DESCRIPTION
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
018x Hospital Swing Beds
022x Skilled Nursing Inpatient (Medicare Part B only)
023x Skilled Nursing Outpatient
071x Clinic Rural Health
073x Clinic Freestanding
074x Clinic Outpatient Rehabilitation Facility (ORF)
075x Clinic Comprehensive Outpatient Rehabilitation Facility (CORF)
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Outpatient Wound Care Billing
It is observed that MACs may update LCDs as often
as they deem necessary hence wound care
professionals should assign someone to review
LCDs every month. When LCDs are revised, all
wound care professionals should read them
carefully. The trend in health care seems to be
moving away from hospital-based wound care to the
more centralized outpatient wound care models
that have benefited patients in the areas of
intravenous antibiotics and now in wound
management. You can outsource your wound care
billing, we can help you to increase your overall
collection. We are a HIPAA-compliant leading
medical billing company. To learn more about our
Wound Care billing and coding services, email us
at  info_at_medicalbillersandcoders.com or call us
at 888-357-3226.