Top 7 Challenges with Wound Care Medical Coding

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Top 7 Challenges with Wound Care Medical Coding
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 Medical Billers and
Coders (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. 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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Top 7 Challenges with Wound Care Medical Coding

• 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.

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Top 7 Challenges with Wound Care Medical Coding

• 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.
• 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. This doesnt mean that
  physicians must use the term extraction, but if
  documentation shows that the tissue was pulled or
  stripped away, rather than cut, the debridement
  is an extraction. ICD-10 will require coders to
  capture laterality and more specific anatomic
  wound locations.
• 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.

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Top 7 Challenges with Wound Care Medical Coding

• 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.
• The billing of wound care services usually
  involves a thorough evaluation of the patients
  medical record for the wound, including wound
  dimensions, chronic diseases such as diabetes,
  chronic ulcers, quadriplegia, and more.
• It also requires detailed documentation of
  procedures offered to manage the wound, follow-up
  visits, initial assessments, photographs of the
  wound, and ongoing progress.
• To overcome these challenges and streamline your
  wound care billing process, partnering
  with Medical Billers and Coders (MBC) is
  essential.
• Get in touch with us today for expert assistance
  and support.
• Call us at 888-357-3226 or email us
  at info_at_medicalbillersandcoders.com to get
  started!