How To Get Optimal Reimbursement For Wound Debridement And Skin Substitutes
Dr. Poggio suggests reviewing the indications for each graft material as some grafts are only allowed for patients with diabetes even though a person without diabetes has a similar wound and/or risk factors. He says one should also get pre-authorization for every graft just to make sure the graft has coverage, noting that many suppliers will do an insurance verification for you.
Dr. Poggio emphasizes that graft material can cost hundreds or thousands of dollars. If the insurance carrier does not pay, the physician is still responsible for the cost of the graft material, points out Dr. Poggio.
“Even though I have worked with surgeons that let the office billers ‘code’ for them based on the dictated op reports, I believe it is the best policy for the surgeon to code his or her procedures since you know exactly what was performed in the particular situation,” says Dr. Suzuki.
Dr. Aung is in private practice in Tucson, Ariz. She is a member of the American Academy of Professional Coders as a Certified Professional Medical Auditor. She is also a panel doctor at Carondelet St. Mary’s Advanced Wound & Hyperbaric Center in Tucson. Dr. Aung serves on the Examination Committees for both the American Board of Wound Management and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine.
Dr. Poggio is a California Podiatric Medicine Association Liaison to Palmetto GBA J1 MAC and a medical consultant to several national health insurance and review organizations. He is a member of the American College of Podiatric Medical Reviewers and is board certified by the American Board of Podiatric Medicine and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine.
Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo.
Editor’s note: For further reading, see “Pertinent Insights On Coding For Wound Care” in the July 2012 issue of Podiatry Today or “What You Should Know About Skin Grafts And Substitutes” in the January 2011 issue.