Wound Care CPT^® Codes 11042 and 29580

Wound care CPT^® Codes 11042 and 29580

Question:

Our wound care physician billed for debriding a wound on the right foot and applied an Unna boot to the right foot. Can we bill for both 11042 and 29580?

Answer:

NCCI has an edit for these. 29580 is a column 2 edit. A modifier is permitted, if circumstances warrant it. That means, for Medicare, you may not bill for both 11042 and 29580 when treating the same wound. Not all payers use NCCI edits. For commercial payers, check to see if your contract requires you to follow NCCI edits. If not, report both. If the unna boot was applied to a different site than the debridement (debridement of a wound on the buttocks, unna boot to a wound that did not require debridement on the foot) then bill the unna boot application with modifier 59.

Members can download the CPT and HCPCS Modifier Coding Guide for an in-depth look at modifiers, or our series of modifier reference sheet for a handy desk reference.

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