And you thought payers were picky? RACs are downright cutting. (sorry, we couldn’t resist)
Wound debridements are on the likely targets list, as listed in a previous post. (The list, by they way, comes directly from the RAC Evaluation Report issued by CMS this past summer.)
Why is Wound Debridement on the list?
Because it is often poorly documented — or that’s what the RACs think now, from past experience. So, they point their software scrubbers at your data (they have every bit of it, you know), and out pops all your debridement claims. Instant list of records to request. You’re lucky that they now have limits on what they can request in any 45-day time period. Ok… back to the debridements.
Debridements come in two forms, Excisiional and Nonexcisional:
Excisional debridement — surgical removal or cutting away of devitalized tissue, necrosis or slough.
Nonexcisional debridement — nonoperative brushing, irrigating, scrubbing, or washing of devitalized tissue, necrosis or slough. Includes snipping of tissue followed by Hubbard tank therapy.
Note the key difference is the “cutting” aspect — essentially, the use of a sharp edged instrument.
Here’s an example. A claim was submitted for an Excisional Debridement, with Procedure code 86.22 assigned. Upon review by a RAC, however, it was noted that the physician wrote “debridement was performed.”
The RAC determined that the claim was incorrectly coded, and repayment was requested.
We’ve said it before, we’ll say it again… documentation is now more important than ever before, and specificity in the documentation is KING.
recovery audit contractor
