Why Wound Care billing is different.
Wound Care billing expertise.
- Selective and surgical debridement coding
- Skin substitute application and product billing
- Negative pressure wound therapy coding
- Multi-layer compression system billing
- Hyperbaric oxygen therapy supervision claims
- Wound measurement and progress documentation review
- Nursing facility and home visit billing
- LCD compliance checks for advanced therapies
Common Wound Care codes we work with.
| Code | Description |
|---|---|
97597 | Debridement, open wound, selective; first 20 sq cm or less |
11042 | Debridement, subcutaneous tissue; first 20 sq cm or less |
15271 | Application of skin substitute graft to trunk, arms, legs; total wound surface area up to 100 sq cm, first 25 sq cm or less |
97605 | Negative pressure wound therapy, using durable medical equipment; total wound surface area 50 sq cm or less |
29581 | Application of multi-layer compression system; leg (below knee), including ankle and foot |
99183 | Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session |
CPT® is a registered trademark of the American Medical Association. Codes shown are examples; correct coding depends on documentation and payer policy.
Our processWound Care billing process.
Eligibility and Authorization
- Coverage verification for advanced wound therapies
- Skin substitute authorization requirements
- Facility and home health status checks
- Patient cost estimates for ongoing treatment
Coding
- Debridement depth and surface area coding
- Skin substitute product and wastage coding
- Compression and NPWT coding
- Diagnosis coding with wound type, site and severity
Claim Submission
- Scrubbing against wound care LCDs
- Frequency checks for repeat applications
- Product units and wastage on separate lines
- Timely electronic submission
Denial Management
- Medical necessity appeals with wound measurements
- Skin substitute coverage appeals
- Frequency denial resolution
- Audit response support
Analytics
- Revenue by therapy type
- Skin substitute cost versus reimbursement
- Visit volume by site
- Denial and payer trends
Wound Care billing FAQs.
What determines the debridement code?
The code is based on the deepest level of tissue removed, such as subcutaneous tissue, muscle or bone, and the total surface area debrided. Notes should document both the depth and the measurements.
Why are skin substitute claims scrutinized?
Skin substitutes are high-cost products with specific coverage criteria, including wound duration and failed standard care. We check documentation against the applicable policy and report product units and wastage correctly.
How is hyperbaric oxygen therapy billed?
The facility bills for the treatment itself, while the supervising physician bills a separate code for attendance and supervision. Only covered diagnoses qualify, so we verify coverage before treatment begins.
How often can wounds be debrided?
Frequency depends on the wound's progress and payer policy, and repeat debridement must be supported by documentation showing why it's needed. We monitor frequency to prevent avoidable denials.