OIG Watching Wound Care: Your Debridement Codes Are in the Crosshairs
Summary: February 2026 Pulse post warns of OIG scrutiny on wound care debridement codes (11042-11047). Focus: Upcoding (deeper than documented), insufficient notes (missing depth, tissue types, debrided amount), lack of medical necessity (no conservative care failure proof). Risks: Audits, repayments, penalties. Advice: Detailed documentation (pre/post photos, measurements, tissue description, rationale), compliance training, internal audits, use of modifiers. Ties to high reimbursement value and fraud concerns; urges proactive measures for sustainability in advanced wound care.
Keywords: OIG audit, debridement coding, wound care compliance