Top 7 Challenges with Wound Care Medical Coding

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Top 7 Challenges with Wound Care Medical Coding

• Medical Billers and Coders

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Medical necessity denials traditionally focus on
high-dollar MS-DRGs, such as those for hip and
knee replacements other MS-DRGs may also soon
become targets. We have identified some of the
challenges in Wound Care Medical
Coding. Healthcare providers are likely to
perform accurate medical coding under ICD-10 and
that is when having an outsourcing medical
billing coding partner like MBC will be
beneficial. Documentation lacks the clinical
substance necessary to support medical necessity,
and it doesnt capture a physicians clinical
judgment and medical decision-making for
performing the procedure. Doctors have been
conditioned to document excisional debridement,
but if you look at what they need for their own
payment, they need to do a lot more than that. To
do wound care medical coding for inpatients
frequently lacks sufficient documentation.
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It has become crucial than ever for wound care
providers to make sure that they are doing coding
to the utmost specificity and following all the
ICD-10 guidelines. While it is still unclear
exactly how forgiving CMS was under this grace
period, it is possible that some things that
were working on in the first year of ICD-10 may
not continue to be satisfactory.
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• The Challenges With Wound Care Medical Coding
• There is a misperception with coding and billing
  is that if there is a code for a procedure or
  product, the insurance plan will pay it. This is
  not necessarily the case. Having a code does not
  directly translate to the coverage for the
  procedure, therefore, it becomes imperative to
  know the rules under which you must operate is a
  must.
• Another common error is not using the add-on
  codes properly. If removing over 20 cm2 of tissue
  at a certain depth, he says to use the base code
  and the add-on code. For example, if removing 28
  cm2 of subcutaneous tissue, he notes the coding
  would be both 11042 and 11045.
• Coders are often too cautious when assigning a
  present on admission (POA) indicator for pressure
  ulcers, especially when the provider does not
  document the ulcer until several days after
  inpatient admission. If signs or symptoms are
  POA, coders can and should report an ulcer as
  POA. A query may be necessary without
  documentation of signs or symptoms.

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• The Challenges With Wound Care Medical Coding
• ICD-10-PCS distinguishes between excisional and
  non-excisional debridement. The ICD-10-PCS root
  operations excision and extraction denote
  excisional debridement and non-excisional
  debridement, respectively.
• There have been disagreements, and debates
  between whats considered to be a wound versus
  an ulcer. Sometimes, ICD-10 is almost like its
  own language, and this is one of those
  situations. Be aware of ICD-10 semantic, that
  medical staff often make mistakes. While many
  clinicians may interchange the terms ulcer and
  wound as if they are substitutes, they are not
  other words when it comes to ICD-10 medical
  coding.
• Physicians respond to the documents during their
  administrative hours. Because manual physicians
  query delays in medical coding and billing and
  dont have a great response rate from physicians,
  providers should consider automated physician
  queries.
• Understand the difference between wound
  debridement, open fracture debridement, and
  active wound care coding. Also there are errors
  in coding correctly when skin grafting/replacement
  is involved.

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The billing of wound care services usually
involves a thorough evaluation of the patients
medical record for the wound, including wound
dimensions, chronic diseases which includes
diabetes, chronic ulcers, quadriplegia, etc.
procedures offered to manage the wound,
follow-up, first visit, photographs of the wound,
and wound progress. To have MBC as your wound
care medical billing and coding partner can help
overcome the above-mentioned challenges.
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