Ask the Board

  In this exclusive column, Today’s Wound Clinic offers our readers the chance to ask industry-related questions to our expert editorial board members. This month’s question comes from Fort Worth, TX.

Q: “I’ve researched Local Coverage Determinations (LCDs) trying to find the maximum number of units billable for the selective debridement add-on 97598 and have not been able to find any specifics as to how many units are billable for this Current Procedural Terminology (CPT®) code. Where will I find this information?”

A: By Kathleen D. Schaum, MS

  “The information you’re seeking is not typically found in LCDs. You should look for your answer in the Centers for Medicare & Medicaid Services’ (CMS) Medically Unlikely Edits (MUEs): www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html. Under “Related Links” you’ll find two sets of MUEs: one for practitioner services and one for facility outpatient services. MUEs are the maximum units of service that CMS would expect a qualified healthcare professional to report under most circumstances for a single beneficiary on a single date of service. Please remember four important facts when reviewing MUEs:

  1) Select the appropriate set of MUEs based on whether you are a practitioner or a facility outpatient service.
  2) Not all Healthcare Common Procedure Coding System and CPT codes have an MUE.
  3) CMS publishes most MUE values on its website. Other MUE values are confidential and are for CMS and CMS contractor use only. NOTE: The code you referenced does not appear to have a published MUE. However, if you have received denials for multiple units of this add-on code performed during the same visit, you will have a good idea of the confidential MUE value for that particular code.
  4) CMS updates MUEs on a quarterly basis. NOTE: Assign someone to review the additions, deletions, and revisions to MUEs at the beginning of each quarter (visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes.html).

  To obtain current coding, payment, and coverage information for qualified wound care professionals and hospital-based outpatient wound care departments, please consider attending a 2013 Wound Clinic Business seminar (www.woundclinicbusiness.com).”

Kathleen D. Schaum can be reached for questions and consultations by calling 561-964-2470 or at kathleendschaum@bellsouth.net. For a full disclaimer related to the information in this column, please refer to Business Briefs on page 6.