Wound Care

“I saw a patient at the wound care clinic, and he presented with an abscess that required urgent incision and drainage. I sent him directly to the emergency room for admission, work-up for sepsis and later that evening performed an incision of the 3rd intermetatarsal space, bone biopsy of the third metatarsal and application of a wound vac. I followed him while he was admitted. I am not sure how to code the initial visit in the wound care clinic. I am not sure about modifiers for the “decision for surgery.” Can I bill for the subsequent daily rounding and changes of the VAC while he was admitted? Could you please advise the proper billing?”

“I am not sure when I should and can bill for an E/M when seeing patients for wound care. Is it reasonable to bill an E/M code if the patient returns for follow up for their ulcer and it is 100% healed? Occasionally hyperkeratotic tissue is present and sometimes I debride the callus to confirm the ulcer has healed. I always spend time on these visits educating the patient on ulcers and the diabetic foot. Would it be appropriate to code for an E/M at this visit since the vast majority of the time is spent counseling the patient prior to discharging them from care?”

“I often provide wound care for hospice patients and append the GW modifier. However, I recently read that it would be hard to defend this as the wound(s) and wound process is likely related to the patient being deconditioned and malnourished due to their hospice qualifying condition. I am looking for clarification regarding this, should I stop performing wound care services to hospice patients?”