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!
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?