Health Information Management

Rejected debridement claims should be resubmitted

APCs Insider, August 23, 2013

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

 Receiving a billing rejection can be frustrating, especially when you’re confident the documentation supports the claim. In a recent case, the rejection may have been erroneous, and affected providers are urged to resubmit those claims for payment.

CMS recently announced the rejection of outpatient hospital claims containing CPT® codes for skilled nursing facility (SNF) consolidated billing (CB).

The rejected codes are:
  • 11042, debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
  • 11043, debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
  • 11044, debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle, and/or fascia, if performed); first 20 sq cm or less

These rejections are occurring because the codes were not removed from the minor surgery inclusion list in the 2013 SNF CB File for FI billing. CMS has instructed contractors to bypass SNF CB common working file edits for outpatient hospital bill types 13x and 85x with dates of service on or after January 1, 2013, when one or more of these CPT codes is present on the hospital claim.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Most Popular