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Top 7 Challenges with Wound Care Medical Coding


Wound Care Medical Coding experts play a key role in every medical practice. Learn more about their challenges they face along the way. – PowerPoint PPT presentation

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Title: 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 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.
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
  • 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.

Top 7 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. 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
  • 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

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 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 Medical Billers and Coders as your wound
    care medical billing and coding partner can help
    overcome the above-mentioned challenges. Get in
    touch with us!
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