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Billing by specialty

Billing built around your practiceAll 14 specialties
Newest guide90837 vs 90834: Billing Therapy Time Without Audits

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Specialty billing

Wound care billing services

Wound care billing is coding each visit’s debridement, grafts and other treatment by the depth and size of each wound, and claiming it with the measurements and notes payers check at every visit.

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Wound care

The deepest tissue sets the code

  1. Wound surface97597
  2. Subcutaneous11042
  3. Muscle or fascia11043
  4. Bone11044
Each code covers the first 20 sq cm; add-ons for each further 20.

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Find the debridement codes

Debridement is coded by the deepest tissue removed and by area, in steps of 20 sq cm.

Which debridement codes?

Depth · area

Pick the deepest tissue removed, then the area.

sq cm
  • 11042
  • 11045

The first code covers the first 20 sq cm, with an add-on for each further 20 sq cm or part of it. Wounds debrided to the same depth are added together; wounds at different depths are coded separately.

Why is wound care billing hard?

  • Depth and area set the code

    Debridement is coded by the deepest tissue removed, subcutaneous tissue (11042), muscle or fascia (11043) or bone (11044), and by area in steps of 20 sq cm. Selective debridement of the wound surface is coded separately (97597, 97598).

  • Several wounds on one claim

    The areas of wounds debrided to the same depth are added together, and wounds at different depths are coded separately, so each wound’s measurements must be in the note.

  • Skin substitutes have two codes

    A skin substitute is billed as the product, a Q code by the square centimeter, plus its application (15271–15278) by size and body area, under coverage rules payers change often.

  • Hyperbaric oxygen has strict criteria

    Hyperbaric oxygen therapy is covered only for listed conditions, such as a diabetic foot wound that hasn’t healed after 30 days of standard care, and is billed per 30 minutes (G0277) with the physician’s attendance (99183).

  • The setting changes the claim

    Wound care is given in physician offices, hospital outpatient clinics, nursing facilities and homes, and the place of service changes how a visit is billed and paid.

What Beeline handles for wound care providers

Wound care billing questions

How is wound debridement coded?
By the deepest level of tissue removed and the total area. 11042 is subcutaneous tissue, 11043 muscle or fascia and 11044 bone, each for the first 20 sq cm, with add-on codes for each further 20 sq cm. Selective removal of dead tissue from the wound surface uses 97597 and 97598.
How are skin substitutes billed?
In two parts: the product, with its own HCPCS Q code billed by the square centimeter used, and the application, with a CPT code from 15271 to 15278 chosen by the wound’s size and body area. Coverage depends on the payer’s policy for the type of wound.
Is hyperbaric oxygen therapy covered for wounds?
Medicare covers it for listed conditions only. A diabetic wound of the lower leg or foot must be Wagner grade III or higher and must not have healed after an adequate course of standard wound care, of at least 30 days. A hospital outpatient department bills it with G0277 per 30 minutes, and the physician’s attendance with 99183.

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