Hot Coding Topics

Clear The Smoke On Debridement And Active Wound Care Codes

Confused about when to choose a debridement code and an active wound code? CPT 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth.

“Depth is the only documentation item you need to determine the correct code,” explained Chad Rubin, MD, FACS, AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member with Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member at their joint presentation “General Surgery” at last month’s CPT Symposium in Chicago.

Active wound care, which has a 0 day global period, is for active wound care of the skin, dermis, or epidermis. For deeper wound care, use debridement codes in the appropriate location.

Example: Codes 11040 (Debridement; skin, partial thickness) and 11041 (…full thickness) have been deleted. The parenthetical note under the codes’ deletion reads, “For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598.” The codes are revised for 2011 to reflect this change. For instance, the revision for code 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) removes “Skin, and” and adds after subcutaneous tissue “includes epidermis and dermis, if performed.”

Code 97597 is revised to (Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq cm or less]).

Code 97597’s revision involves “mainly rewording to make clear how active wound care is separate from integumentary wound care,” Bothe explained.

CPT...

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December 15, 2010
2011 Medicare Physician Fee Schedule / CPT 2011 / CPT and RBRVS Annual Symposium / Hot Coding Topics

Peds Win Per Component Vaccine Admin Codes, Lose Requested PE RVUs

Pediatricians who were thrilled with CPT 2011’s move to paying vaccines per component got a setback from Medicare’s rejection of the recommended RVUs for new vaccine administration codes 90460 and 90461.

The Relative Update Committe recommended that the 2011 Medicare Physician Fee Schedule and Resource Based Relative Value Scale assign 0.20 practice expense (PE) RVUs to 90460 and 0.16 PE RVUs to 90461. But CMS disagreed with the proposal. “We disagree with the recommendations and will maintain 0.17 RVUs for code 90460 and 0.15 RVUs for code 90461 since these codes would be billed on a per toxoid basis,” said Kenneth Simon, MD, MBA, Senior Medical Officer, Center for Medicare and AMA CPT Editorial Panel Member, in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT® and RBRVS 2011 Annual Symposium on Nov. 10, 2010.

The increased PEs represent an increase in RVUs from the 2010 values for comparable codes 90465/90467 and 90466/90468. The RUC requested the increase in value due to increased time for patient education. Since the new codes are valued per component, CMS felt no increase was warranted.

CMS assigned RVUs to 90460 and 90461 by crosswalking them with the values of the noncounseling vaccine administration codes 90471 and 90472. This means that new code 90460 has the same RVUs as 90471, and each unit of 90461 has the same RVUs as 90472.

The work and total RVUs for the codes include:

<td width="203"
Code PE  RVU  RUC Proposed PE  RVU MPFS Accepted Total RVUs
90460 0.20 0.17 0.59
90461 0.16 0.15 0.3
90465

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November 29, 2010
CPT / Provider News

Neonatal Critical Care Coding: CPT 2010 Clarifies Resuscitation Guidance

Payers denying 99465-25? Here’s help straight from the AMA Symposium in Chicago. Question: There’s a notation in the CPT 2009 manual that the neonatal critical care codes include delivery room resuscitation. Is this true? Answer: No, a parenthetical note following 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute [...] Related articles:

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November 15, 2009
CMS / CPT / Medicare / Provider News

Medicare Changes to 2010 CPT Inpatient Consultation Codes

Prevent 99251-99245 denials in 2010 with this checklist. Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do. Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles [...] Related articles:

  1. Medicare 2010 CPT Consultation Code ChangesNew rules for consult coding straight from the AMA Meeting...
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  3. Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open...

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November 13, 2009