You Cannot Afford to Use Old Coding Books

–Kathleen D. Schaum, MS

  This week I received a call from the vice president of a hospital-based outpatient wound care department (HOPD) who was very concerned because an auditor had informed him that the HOPD had not been paid for many of the debridement procedures in the HOPD the last 2 years and for all of the applications of skin substitute procedures over the past year. Additionally, the HOPD was not paid for most of the cellular and/or tissue-derived products for wounds that they had applied. Making matters worse, many of their clinic visits for patients living with diabetes have been denied for numerous years.

  Of course, I was wondering, “How could the HOPD not know it wasn’t being paid long before the auditor arrived?” I will save that discussion for another time.

  I asked the VP to send me a copy of the HOPD’s charge sheets and Charge Description Master (CDM). To my surprise, both of these charging tools listed the debridement codes that were deleted in 2011 and the application of skin substitute codes that were deleted in 2012. Although the HOPD used numerous cellular and/or tissue-derived products for wounds, it only had one “Q” code on the charge sheets and CDM: it was billing all the brands with the same “Q” code. Finally, the charge sheets listed the old ICD-9-CM codes for diabetes that were revised many years ago.

  I then called the HOPD and officials to check the calendar year that was printed on the front of their Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS), and ICD-9-CM books. To my amazement, the books were very old. When I asked the VP why the HOPD did not have current coding books, he said that he removes those items from the HOPD’s budget request every year because he buys coding books for the hospital coders and “that should be sufficient.”

  I then asked the VP if any of the coders were specifically assigned to the HOPD. You guessed it – he said the HOPD was responsible for submitting codes to the billing department! I wondered to myself, “How could the HOPD successfully submit the proper codes if it did not have the current coding tools?”

  Unfortunately, I receive many calls from HOPDs and physician offices that experience similar problems. The typical response when I ask about the age of their coding books is: “We are not allowed to purchase coding books every year.” The old saying, “penny-wise and pound-foolish” absolutely describes these situations.

  If you have not purchased the 2013 CPT Current Procedural Terminology book, the 2013 HCPCS Level II book, and the 2013 ICD-9-CM book, you should do so NOW. Then, mark your calendar to order your new books each year in September.

  For an overview of the 2013 coding changes that pertain to wound care, see my next Business Briefs article in Today’s Wound Clinic: The article will be available by mid-February.

  For an in-depth discussion of the new/changed/deleted 2013 codes, mark your calendar to attend the all-day 2013 Wound Clinic Business seminar in the city of your choice: Better yet, bring your entire revenue cycle team and your medical staff to the seminar: It is a great opportunity to learn together!

1CPT is a registered trademark of the American Medical Association

Kathleen D. Schaum is president and founder of Kathleen D. Schaum & Associates Inc., Lake Worth, FL. She can be reached for questions and consultations by calling 561-964-2470 or at

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