November 13, 2014
I am working in a wound care center and we are billing 97597, 97598, 11042, 11045 codes extensively. My question is this: is there a unit limit that Medicare will accept on the 97598 or 11045 codes? I have two separate patients who are in a situation where the units billed would be over 40 and I just don’t know if I should even try to bill this many units or not. I have looked on the MC website, gone to blogs, put questions out on the coder’s websites, and I’ve found nothing that says there is a limit, but I just want some kind of an educated response from someone before I go ahead and bill this. These amounts seem extreme to me even though my provider did do this much work.
Yes, there will be a limit on the number of units the add-on codes (97598, 11045) that Medicare will pay. Medicare implies this limit with the MUE edits (medically unlikely edits) which can be found by clicking here or by going to http://tinyurl.com/lxj69gt and click on the Practitioner edits. What Medicare does not tell us is the exact number of units that will be allowed. So you should bill for what you do and is documented. If it’s denied, then appeal with your good documentation.