Wound Care Coding Guidelines In 2013

With immense coding and billing changes this year, wound care codes are no exception. In fact, there are considerable changes to CPT codes and coding guideline changes every year. Some of the important changes in wound care coding guidelines are as follows:

• Degree specific codes have been removed. So now all appropriately trained and licensed healthcare practitioners or in a more professional term “Qualified Healthcare Professional” can use all CPT codes. This means that there will be no PT codes or RN specific codes including surgical codes which are also not physician specific. Qualified healthcare professional can also use a code that describes a procedure appropriately specifying providers training and scope of practice.
• At present, the only thing that will be taken into consideration is that if the code describes adequately the procedure that was performed. So, the use of code 97597 used to describe debriding necrotic tissue from a wound will be taken into consideration which was previously only used as a PT code. Also the once superficial codes, 1104x have undergone revision and at present will be used to bill only for debridement of muscle, fascia and bone.
• There are some terminology changes as well which are as follows:

1. The term provider has been changed to “professionals”
2. The term practitioners has been revised to “individuals”
3. Physicians can now be termed as “qualified healthcare professionals” or “individuals”

Although these changes seem to be minor, they have a considerable effect on how CPT codes will be interpreted and used in 2013. And, what needs to be taken into consideration is that misuse of these codes can lead to serious charges of fraud. For instance, these changes imply that the term “physician” is no longer a part of the descriptions for surgical or E&M codes. The codes will focus more on what has been done rather than who has done it.

Also, the definition of modifier 25 has undergone changes and now stands as “Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service….”

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Source From : http://www.audioeducator.com/medical-coding-billing/wound-care.html