Q&A: CPT coding for E/M visits with wound care

April 16, 2021
Medicare Web

Q: Is it appropriate to report an E/M code for visit services provided in conjunction with a wound care procedure?

A: E/M visit codes are not usually billed in conjunction with wound or ulcer procedures. Keep in mind that outpatient encounters for wound care procedures involve examinations and assessments, cleansing and debridement, and removal and reapplication of wound dressings.

If the provider performs distinct and separately identifiable work, it may be documented using an E/M code and modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). The service must be performed for a condition unrelated to the scheduled visit and must be a new condition that requires further evaluation. For example, an E/M code with modifier -25 may be billed if the provider diagnoses a new ulcer or orders laboratory tests for an unrelated condition.

Editor’s note: This question was answered by Gloria Miller, CPC, CPMA, CPPM, former vice president of reimbursement services at Comprehensive Healthcare Solutions Inc. in Seattle, during the HCPro webinar, “Clean Up CPT/ICD-10-CM Coding and Billing for Wound Care.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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