Transcript

Jayesh Shah, MD, UHM(ABPM), CWSP, FAPWCA, FCCWS, FUHM, FACP, FACHM:

I am Dr. Jayesh Shah, and I am a president of Timeoxygen Healing Concepts, which is a consulting for organization that I run and consult for wound care and hyperbaric medicine. I was in private practice for 28 years and was medical director for 2 wound centers in a hospital-based setting. And now I work as a wound care physician for Audie VA hospital in San Antonio. And I'm a CMO for PACT 2 at Northwest Health Center. 

Basically, again, remember ICD-10 is the 10th version. So these are codes that have been developed to really give an exact kind of diagnosis for what you're doing. There's tons of codes, and I know ICD-10 is what we are using right now, and there will be a movement in future to go to ICD-11. And what happens is, as we go on, these ICD-10 codes keep on increasing in size, the numbers keep on going up, and it gets more and more specific to what you are doing. 

So for an example, for wound care, if you are doing a debridement of a wound, then you need to have a right ICD code that can match with your procedure. And for example, if you are debriding a diabetic foot ulcer, then you need to have a code for diabetes with ulcer and you should have a code of where the location of that ulcer is. Is that ulcer is on the left leg or the right leg or on the foot? So you need to have those specific codes so then it can match with your procedure that you are doing. Suppose if you're doing compression therapy, then you have to have a code that matches with it. So are you doing compression therapy because you have a venous ulcer on the left leg? And there is a specific code for that. So that's what as a wound care doctor you need to know, or a wound care provider, you need to know what are your specific codes that match with your diagnosis. 

I think it just depends. If you are doing wound care, just wound care, then the main common codes you're looking at is knowing diabetes with foot ulcer or diabetes with a leg ulcer code. And if you are going with venous stasis ulcer, then you need to have venous stasis with ulcer, venous stasis with ulcer and inflammation code. It has to be specific whether it's right or on the left. If you are doing arterial ulcer, then you need to have peripheral vascular disease with ulcer. If you have a pressure injury, then you need to have pressure stage 1, stage 2, stage 3, stage 4, pressure ulcer with location, whether it's in sacral area, whether it's in ischial area, whether it's in back, whether it's on the heel. So you need to have those specific codes for the diagnosis that you are treating. 

So if you have a patient who comes to you for evaluation, for example, for diabetic foot ulcer, and then you have to make sure that your history matches. A lot of times, if it is within 30 days, then you have to pick a code which are basically secondary to acute event, maybe secondary to trauma or surgery. But most cases we get are patients for chronic wound management. So you have to basically then use an ulcer etiology. So suppose if you have a person with diabetes with a foot ulcer who has not been healing for more than 30 days, then now you want to use a code which is very specific. You have to ask whether it's diabetes type 1 or whether it's diabetes type 2. So once you know it's diabetes type 2, then you have to use a code, which is diabetes type 2 with foot ulcer, right? Or if it's in the leg, then you have to use diabetic leg ulcer. Then you want to make sure that you have another secondary code which goes with the diabetic code because you have to think about what kind of treatments this patient might need. And because your codes have to match, so you also need a secondary code of L97, which is location. So it tells you the depth and the location. So you can put a secondary code of L97 and where the wound is, whether it's in foot, it will be 5, and then you put a category. If it is 521, it's up to skin, 522, it is up to the subcutaneous tissue. Then if it's 523, that it's muscle and tendon, 4 is up to bone. So that's how you have to go and also have a secondary code of what is the depth and what is the location of the wound. 

Now why that is important is, suppose if you do debridement, then you need to know if you are doing debridement up to subcutaneous and muscle. And if your ulcer code does not match, then it'll create an audit. Because if your ulcer is up to subcutaneous tissue, if you code up to subcutaneous tissue and you end up doing debridement of muscle and tendon, then automatically it causes mismatch and can trigger an audit. So this is why you have to be very, very careful in selecting the right code depending on your assessment of your wound and what you are looking at. And having that is so important. If you're going to do hyperbaric oxygen therapy, then your regulations are pretty specific that you have to have a diabetic foot ulcer for more than 30 days, which has not been healing, and it has to be Wagner grade 3 and higher. So you need to have those scores so that it matches and it doesn't trigger audit. So you have to have a good assessment, good history, and good knowledge about coding to be able to match your diagnosis, which do not kind of trigger an audit. 

I think what I would like to say is having a knowledge about ICD-10, reading your local coverage determination on specific diagnosis and what ICD-10 codes are covered. Because you have a specific codes that allows to cover you for debridement. There are specific codes that allow you to cover for hyperbaric oxygen therapy. So every procedure you do for total contact cast, there are specific codes. So every procedure you do in wound centers or in wound clinics, you have a specific code that matches and your history, your physical, your wound assessment, your ICD coding and the procedure code, all has to match, all has to make sense or have a rationale, because if you are doing it wrongfully, then you could be considered you're doing fraud or abuse. So you need to know the correct diagnosis and correct coding so that you can prevent audits and make sure that you are doing it in a compliant way.

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