Wound care coding

[air bud]

Ok, I hate to try and make this forum a place of useful discussion...but here goes. Let's talk about wound care coding. Specifically related to global periods.
Patient has a TMA. It dehisces. They follow up with you at wound care.

Is that still an ulcer or is a dehiscence?

Is debridement billable?

Does it matter if excisional vs non excisional?

If you need to culture, get images, vascular testing related to it not healing....is that an EM?

If the Answer to all this is no, all part of global...should you see these in wound center or have someone else see it since will be billable by them?

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[MicroPod]

I think if they develop an infection or other issue at a postop visit, you should be able to bill e/m since its a new problem you are putting as a diagnosis. Not sure about ulcer vs dehiscence question.

 

[Adam Smasher]

Everytime I do an amp, instead of saying that I closed the wound, I'll document that "The wound edges were reapproximated with 2-0 prolene [or whatever] retention sutures to allow for definitive closure at a future date if necessary."

This way any debridement or incision revision during the postoperative global are technically part of a planned staged approach and can be billed with a -58 modifier. By the way, this is on paper the vascular surgery approach to amputations, just cut it off and leave a bloody stump to let it heal in secondarily, so don't tell me it's not the standard of care.

And yes I try to avoid doing this, I would rather the operation be one and done

 

[GreenHousePub]

Are we on IPED connect right now?