Reimbursement for Total Contact Casting and Debridement

Few things in life are more complicated than medical reimbursements, we believe this (table below) to be accurate for TCC based on how current clients are billing. Also this is from SuperCoder on debridement:

As per NCCI edits total contact cast application (29445) cannot be billed separately from a debridement (97597) when treating the same ulceration/same anatomical location for medicare as of above scenario. However, Commercial payers may consider separate payment with appropriate modifier.

Also from SuperCoder on CPT codes for debridement:

CPT code 97602 can be used for removal of devitalized tissue from wounds when non selective debridement (chemical method, hydrogen peroxide, iodine, Pulsed lavage method etc.) method is performed.
CPT codes from wound debridement series (11042 – 11047) can be used if active debridement is performed with surgical instruments (forceps and scissors to remove infected or dead tissue material from the wound). Here code selection depends on the depth of the tissue removed e.g. for debridement up to level of subcutaneous tissue – CPT code 11042 is the correct CPT code.

This from medicarepaymentandreimbursement.com on reimbursement fees:

11042-Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square cm or less. – average fee payment- $120 – $130

Speaking of debridement, our medical adviser is a big fan of EZ Debride. More info can be found here: ezdebride.com

Total Contact Casting is the Gold Standard for the treatment of a neuropathic foot ulcer with an 89% healing rate. The M-Med offloading solution is the Gold Standard in Total Contact Casting with 50% more padding for patient comfort and safety. The so called ‘easy’ solution often leaves the patient with iatrogenic lesions and is inadequate for larger patients. If your patient is a little old lady or a NFL lineman M-Med has you covered.

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