Health Information Management

Wound coding

APCs Insider, August 24, 2003

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

Briefings on APCs FREE Sample APC Answer Letter FREE Sample

August 29, 2003
Vol. 4, No. 34


More is not better

What disease increased by 49% from 1991 to 2000?

The answer will appear in next week's APC Weekly Monitor, or be one of the first five to e-mail the correct answer and win a 3-month free trial to one of our APC newsletters!

Most people over the age of 60 have lost half of their

Window Shopping Monitor-Style
We've got terrific resources for your APC coding team. Check out our two APC newsletters.

"Briefings on APCs" is a monthly newsletter devoted entirely to managing under APCs, including tips, charts, and advice from the experts.

"APC Answer Letter" is a question and answer publication - readers supply the questions, our experts supply the answers. Click on the links to find out more.


2003 Annual National Conference
American Medical Billing Association
October 2-3, 2003,
Las Vegas
AAPC Approved for 10 CEUs. Review the agenda and conference details HERE.

IRP, Inc.


Specifically designed for Medicare APC compliance, IRP's coding software fits ALL platforms and is easily integrated with existing applications. Visit our comprehensive APC Reference Library.

Click or call 800-634-0496 x244.


Medical Necessity Solutions

With Info-X you can integrate your local LMRPs and NCDs into your HIS. Leverage existing system capabilities to provide ABN alert, print the ABN and apply the appropriate occurrence codes.

Increased reimbursement, minimum cost, risk, infrastructure, training/education & least time to implement.

For more information, click here or call 800-299-1091 ext. 34.


Keith Siddel,
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Andrea Clark
Health Revenue Assurance Associates

Cheryl D'Amato,
director, health information management
HSS, Inc.

Julie Downey,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,

Julia R. Palmer
president, Health Information Management Division

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System




OIG review finds outlier payment errors in one of the nation's top hospitals

A recent Office of the Inspector General (OIG) review of a Chicago-based academic medical center showed it had received inaccurate OPPS outlier reimbursement.

But not by much. Out of $83,805 worth of outlier payments reviewed, Rush-Presbyterian-St. Luke's Medical Center was overpaid by $7,726 and underpaid by $7,752. The facility is required to return the overpayment, and will attempt to recoup the loss of the $7,752, resulting pretty much in a wash.

But all hospitals may not be this lucky. Take notes and learn from Rush's experience.

The OIG reviewed Medicare outpatient claims with outlier payments of at least 85% of the total claim reimbursement for services performed August 1, 2000 through June 30, 2001.

Out of a sample of 50 claims, 38 were reimbursed incorrectly. The 35 overpayments were not the fault of the facility, however. Its fiscal intermediary's claim processing system had "an outlier pricing issue" which caused these errors.

Rush did make a mistake when it did not use HCPCS codes when billing for implantable devices, creating the three underpayments. The hospital would have received higher reimbursement if the HCPCS codes had been correctly used.

Your APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

The Monitor is a complimentary companion publication with a specific mission: to provide answers to your tough questions about the APC regulations.

If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at Each week, our team of experts answers a question that will appeal to the majority of readers. The elected question and the corresponding answer are delivered to your inbox every Friday.

TODAY'S TOPIC: Wound coding

Question: For a patient seen in the wound center for wound treatment using debridement, do we code and bill both a visit code and the debridement CPT code? For a patient seen in the burn center for burn treatment with whirlpool and dressing changes, do we code and bill both a visit code and the whirlpool/dressing change code?

Answer: When a patient is seen in the wound care center for wound treatment via debridement, the coding depends on the circumstances of the visit.

Was the patient presenting specifically for the debridement or was the patient presenting for evaluation of the wound? If for debridement, only the wound debridement code would be used.

If the patient was presenting for evaluation of the wound and after evaluation it was determined that debridement was necessary, both the E/M code and the debridement codes should be billed, since the patient was evaluated and the management was determined based on that evaluation.

Make sure the debridement was medically necessary. The documentation in the medical record should be evaluated to determine how to code each individual case.

When the patient is presenting specifically for whirlpool with dressing changes, only the whirlpool should be coded. If the patient presents for evaluation and it is determined that whirlpool treatment is necessary, an E/M visit code is billed.

Dressing changes should not be separately billed. If only a dressing change is performed, an E/M code should be assigned.

PAY PER VIEW: Doctors aren't the only providers with documentation deficits

In HIM and compliance circles, we're always discussing the lack of thorough documentation by physicians. But documentation problems often go beyond the doctor-to nurses, therapists, and case managers.

Read more HERE. The cost is $10. Medical Records Briefing subscribers have free access via their online subscriptions.

ASK THE EXPERT: We have been reporting the new 2003 CPT codes and noticed a distinct difference in coding and documentation instructions for excision lesions. How will this affect our APC payment?

Read HERE for the expert's answer!

Coding and Compliance Feature Article of the Month: Cross-training, certification focus push Florida coders up the ladder

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.


What do you know about interventional radiology coding?

Interventional radiology coding is a unique process. It's not like other kinds of coding, where one (or a few) codes describe every aspect of a procedure. With interventional radiology, every component must be coded separately— and accurately— or the claim won't be paid on time.

Join us for "Interventional Radiology Coding: How to Ensure Accurate Coding to Get Your Claims Paid the First Time" on Thursday, September 25, beginning at 1 p.m. Eastern.

For more information or to register, CLICK HERE, or call our Customer Service Team at 800/650-6787. Be sure to mention source code EZ21919A.

It's time to prepare for the new 2004 ICD-9-CD codes
And we have just what you need to get ready.

It's the 2004 ICD-9-CD Training Kit. You get a trainer's package with a plan to help educate staff on all of the changes, along with flyers and a Q&A section.

You also get 10 coder handbooks, which include reference guides and clinical explanations for each new code so coders understand why and how each code should be applied.

It's a steal of a deal at only $99. If you need more, we'll sell you additional coder handbooks in packages of 10.

Ordering is easy. Just CLICK HERE, or call our customer service department at 800-650-6787. Be sure to mention Source Code EB21900B.

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

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular