Pay Attention to Code Descriptions

By Kathleen D. Schaum, MS   Recently, I have received numerous calls regarding Medicare underpayments and overpayments for wound care-related services, procedures, and products. In each case, the incorrect payment was a result of the wound care professional not paying close attention to code descriptions. Following are a few of the reported incidents:     • Physician offices reported that they only received a small fraction of the average sales price attached to several cellular- and/or tissue-based products for wounds (CTPs). Upon review, I identified that they reported a unit of “1” on their claim forms because they used one piece of the CTP. However, the code descriptor of every CTP that the physicians purchased and applied was “per sq cm.” Instead of receiving payment for the 21, 38, and 44 sq cm that they applied, they received payment for only 1 sq cm because they only billed for 1 sq cm. Therefore, I caution you to be sure that your billing system is capturing the correct number of CTP sq cm applied.     • Physicians supervising hyperbaric oxygen (HBO) therapy received requests to repay Medicare because they were overpaid for this work. Upon review, I identified that the physicians were billing for 4 units of 99183 (HBO supervision) per patient encounter. When I asked the physicians, “Why did you bill 4 units?” they answered: “Because the hospital-based outpatient department (HOPD) billed 4 units.” Unfortunately, the physicians did not realize that the HOPD code descriptor for C1300 (HBO therapy) is “per 30-minute intervals” and the physician code descriptor for 99183 (HBO supervision) is “per session.” Therefore, HOPDs typically bill 4 units to account for the 120 minutes of HBO therapy that each patient receives. Physicians should only bill 1 unit of 99183 for each HBO session they supervise.     • HOPDs received requests to repay Medicare because they were overpaid for the application of CTPs. Upon review, I identified the HOPD selected the procedure code for the application of CTPs based on the size of the product ordered and opened. They should have selected the code based on the anatomic location and size of the wound surface area that received the CTP. For example, one physician ordered and opened a 44 sq cm piece for a 15 sq cm foot wound. The HOPD incorrectly coded “1” unit of 15275 to account for the first 25 sq cm of wound surface area, plus “1” unit of 15276 to account for the additional 19 sq cm of product purchased. Unfortunately, the HOPD should have only coded “1” unit of 15275 to account for the 15 sq cm wound surface area. Please educate your wound care professionals, coders, and billers that the application of CTP codes is not billed per sq cm of product purchased and opened. The application of CTP codes should be selected based on the anatomic location and the wound surface area that received the CTP.   Wound care professionals should review the descriptions of the codes that are relevant to wound care related services, procedures, and products that they provide. Make any needed adjustments to your coding practices, which will prevent future underpayments and overpayments. For an in-depth discussion of the wound care coding rules, mark your calendar to attend the all-day 2013 Wound Clinic Business seminar in the city of your choice: www.woundclinicbusiness.com. Better yet, bring your entire revenue cycle team and your medical staff to the seminar: It is a great opportunity to learn together! Kathleen D. Schaum is president and founder of Kathleen D. Schaum & Associates Inc., Lake Worth, FL. She can be reached for questions and consultations by calling 561-964-2470 or at kathleendschaum@bellsouth.net. Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure the accuracy of the information. However, HMP Communications and the authors do not represent, guarantee, or warranty that the coding, coverage, and payment information is error-free and/or that payment will be received. The ultimate responsibility for verifying coding, coverage, and payment information accuracy lies with the reader.