Debridement denials

I code for a general surgeon who considers debridement of certain post-op wound infections and non-healing surgical wounds absolutely necessary. However, as you know, Medicare covers debridement of ulcers and traumatic wounds only. We end up writing off a lot of wound care because of this. Is there any other solution?

Also, consider this delimma: if necrotizing fascitis is on the abdomen or perineum, the debridement (11004 -11006) gets paid, but if it is on the leg (11043) it gets denied. We have a claim like this for $3000.00 that has to be written off. Any suggestions?

re: Debridement denials

I don't have an answer but I have the same questions. I will continue to follow this thread. Thanks, Beth

re: Debridement denials

If you look at the Medicare Claims Processing Manual, the global fee includes all post op follow up including complication unless a return trip to the OR is required.

re: Debridement denials

To the editor; thank you for your response. I failed to mention that these denials are not due to global issues, but due to "medical necessity". In the example I gave, the Dx for necrotizing fascitis is not covered Dx for any of the debridement codes 11042 etc. This is a new patient, no global issue, and it is not a post-op wound, but fascitis in the leg.

In the mean time I have discovered that Medicare pays debridements on "other specified local infections of skin and sub. cu tissue" Dx 686.8 and 686.9 (unsp. infection of skin). They do not pay for cellulitis Dx 682.X. See my frustration? If the documentation is vague, the treatment gets paid....if the documentation is specific (cellulitis), it gets denied.

Any feedback greatly appreciated!