Billing wound care supplies and debridement together can be tricky. It is essential that medical practices follow the following guidelines:

1. Billing Wound Care Supplies and Debridement to Medicare.

A6010, or Collagen Powder, are wound care supplies and they need to be billed to DMERC, whereas 11042 is a debridement code that gets billed to Medicare. These are two separate claims that get billed to separate insurance companies. When the patient has Medicare, you can bill for wound care supplies and perform a debridement on the same day.

2. Billing Wound Care Supplies and Debridement to Private Insurance Companies/Replacement Plans/Advantage Plans.

Most of the time, advantage plans, Medicare replacement plans, and private insurance companies will NOT pay for the same-day dispensal of wound care supplies when billed in conjunction with a debridement.  These insurance companies incorrectly believe providers are unbundling the wound care supplies from the debridement code. Therefore, wound care supplies are NOT covered on the same day of debridement.

You Have Three Options:

  1. The patient can pay for the wound care supplies on the same day and sign an ABN.
  2. They can pick them up at the clinic the next day.
  3. AMERX can overnight the wound care supplies directly through their Turn-Key DME Patient Direct Program.

All three options allow you to be paid for both the wound care supplies and the debridement.

In Conclusion

If you are getting denials for wound care supplies, make sure you are not billing them with any debridement codes.

Holly Burkman
Holly Burkman, MBA

Holly is a recognized international speaker and author. Working with her husband to build a medical practice from the ground up, she has handled all aspects of the podiatry field from medical assisting to billing and practice management. Currently, she spends her time as a practice management consultant helping physicians learn how to run successful medical practices by implementing protocols. Holly holds numerous degrees and certificates that give her the credibility to help practices; however, it is the years of personal in-office experience that allow her to offer customized solutions that make practices profitable again.