Hi Jennifer

Other colleagues might have other input, but here are some thoughts:

It'd be important to make sure the patient is not under a Medicare-certified home health plan for the same condition being treated, as Medicare does not cover physician home visits (e.g., CPT 99344, 99349) if there is overlap with home health services for the same issue.

Additionally, common reasons for denial of surgical debridement codes (e.g., 11042) include:

1. Performing deep debridement in a setting other than an inpatient hospital, outpatient hospital, or ambulatory surgical center (ASC)


2. Billing debridement performed by personnel who are not qualified

For more information, refer to the topic:

Coding and Billing Essentials in Wound Care on WoundReference.

Hope this helps,

Jennifer,

This may be a consolidating billing issue...check the EOB for the reason for the denial...and then check with ypur fiscal intermediary regarding their considating biiling rules. Kathy Schaum did a great article on consolidating billing on skilled nursing facilities in Advances in Skin and Wound Care..an easy Google search fpr the read....the same concept applies here, too.

Cathy