Forum - Questions & Answers

Feb 25th, 2011 - kanderson

Debridement denial for medical necessity

Hello all,

We billed 97597 for epidermal debridement with dx code 110.0. Medicare denied is as not medically necessary, but they have never denied debridement like that before. Is it a problem with the new codes or should I send a redetermination? Thanks for the help!

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Feb 26th, 2011 -

I would appeal

but honestly I have never heard of debridement for that

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Feb 27th, 2011 - Codapedia Editor 1,399 

Denial for debridement

the most commonly billed diagnosis codes are ulcers in the 707.XX range.

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May 16th, 2013 - Maarit 7 

re: Denial for debridement

Dear Betsy Nicoletti,
I enjoyed your workshop in Chicago a year ago! I'm your fan.

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 have appealed our denials to no avail. I wonder now if a non-healing wound from a surgery of several months prior (outside global) can be considered an ulceration?

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?

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Feb 28th, 2011 - jschmutz   323 

Debridement denial for medical necessity

Why would a sharp debridement be medically necessary for dermatophytosis?

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