Health Information Management

Tip of the week: Wound dressing is a bundled procedure when assessment is part of therapy

APCs Insider, August 15, 2008

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According to most Medicare local coverage determinations for wound care or physical rehabilitation, routine dressing changes do not usually require the skills of a physical therapist. Medicare local coverage determinations also consider routine dressing changes as bundled to any other therapy procedure or modality performed by the physical therapist or physician on the same date of service.

Consider the following example:

A physical therapist performs a wound assessment as part of an encounter with an established patient who receives a new prosthetic or for prosthetic follow-up.

The physical therapist should report CPT code 97761 (prosthetic training, upper and/or lower extremity[s], each 15 minutes) when a patient presents for fitting of a new prosthesis and training in the use of that prosthesis. The February 2007 CPT Assistant, pp. 8, 9, and 12, explains that the initial fitting ?includes preparation of the stump, strengthening of the remaining musculature, modification of prosthetic fit using stump socks or socket liners, mobility training, use during functional activities as well as skin care and overall conditioning.?

Code 97762 (checkout for orthotic/prosthetic use, established patient, each 15 minutes) is ?intended for established patients who have already received the orthotic or prosthetic device (permanent or temporary), according to the December 2005 CPT Assistant, pp. 8 and 11.

It further states that the checkout visit should also include assessment of:

  • The patient?s response to wearing the orthotic or prosthetic device (e.g., possible skin irritation or breakdown)
  • Whether the patient properly dons the orthotic or prosthetic device
  • The patient?s need for socks, padding, or underwrap
  • The patient?s tolerance to application of dynamic forces
If the assessment leads to routine wound dressing performed by the physical therapist, Medicare will reimburse this service as part of the primary procedure. Therefore, do not bill it separately. You may report supplies separately.

CPT codes 97761 and 97762 are time-based therapy modalities and should be ordered by the physician or therapist as part of a certified therapy treatment plan.

The Medicare Benefit Policy Manual, Pub. 100-02, Chapter 15, section 220.3, paragraph E, states that daily treatment notes should include ?total timed code treatment minutes and total treatment time in minutes. Total treatment time includes the minutes for timed code treatment and untimed code treatment.?

(This tip was adapted from APC Answer Letter. To view the entire tip, click here.)

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