What Do You need To Know About Wound Care Billing?

Touseef Riaz

October 5, 2022

wound care billing

When you have been injured, getting the proper treatment is essential. It can be a struggle without medical insurance or other financial resources. Fortunately, there are many different options for people who need wound care. Since many factors go into wound billing, you can’t just base your fee on the size of the wound or the region it was in. Here are answers to some common questions about wound care billing. Keep reading to know more! 

wound care billing

What has wound billing?

It is also known as medical coding, which refers to determining the appropriate payment for treating injuries, wounds, and blood loss. It is an industry that has experienced tremendous growth over the last several years. The number of people who require therapy and medications related to these injuries continues to rise.

Importance of wound care 

What involves in wound care? 

Wound healing is a complex process involving epithelialization, fibroplasia, and wound vascularization. Wounds are usually classified as surgical or traumatic, or incised. In addition, the healing process can be affected by age, sex, race, and body mass index (BMI).

Cutaneous wounds occur in the skin and may heal with good cosmetic results but leave behind scars or keloids. The skin may also develop inflammation, infection, and redness due to trauma caused by organisms like bacteria or fungi.

The main goal of any wound care program is to promote healing by minimizing complications such as infection and dehiscence (openings in the skin) while allowing normal function and appearance to return to normal.

Skin closure requires an intact dermis (inner layer) with a viable epidermis (outer layer), which must be well-vascularized for regular tissue repair and proliferation. Wounds do not heal unless they have an intact epidermis overlying viable dermis with sufficient blood flow through them so that the damaged tissue can repair itself.

CPT code for wound cleaning and dressing: 

Wound cleaning, dressing, and bandaging help you maintain your health avoid complications and promote healing. Wound cleaning is the removal of dead tissue and debris from wounds. Dressing refers to applying a sterile disposable dressing to an injury to keep it clean and protected during healing. Moreover, bandaging uses the material to support wounded parts of your body to prevent movement or damage. So, here are the codes that are used: 

Code 97612 describes “cleaning procedures performed by a health care professional to remove foreign material or debris from wounds or to remove necrotic tissue from injuries when it constitutes a risk for transmitting infectious agents. Moreover, this code is used by healthcare providers working with patients with open wounds, such as those caused by cuts, scrapes, burns, and other injuries. It applies when there is a risk of infection from the harm and requires that the damage be cleaned before it can be closed.

The code also applies if there is an active infection in the wound and the body’s Immune system cannot effectively attack the illness. In this case, cleaning may help eliminate some of the bacterial or viral agents causing disease in order to more effectively treat them.

Additionally, the application of dressings to the wound is a component of the service for wound care (CPT code)codes 11000–11012 and 11042–11047, and they cannot be independently billed.

Follow these instructions to use CPT codes 97598, 97597, and 11042–11047:

  • The primary dressing does not necessarily mean you will have to change it. It means that there was an injury, and you have to treat it. You can’t charge for changing a dressing because your patient did not have an injury; they had a wound.
  • You can bill for debridement, but only if active treatment occurs during that period. You cannot bill for debridement if they sit with bandages on.
  • The CPT code for cleaning wounds is 97612, which describes “cleaning procedures performed by a health care professional to remove foreign material or debris from wounds or to remove necrotic tissue from wounds when it constitutes a risk for transmitting infectious agents.”
  • The patient should be counseled about wound care at each visit and instructed on how to perform wound care at home.
  • The Cpt code for wound care is 11042 – 11047 and should not be used when documenting medical treatment services. For instance, callus removal, bacterial washing, lesions containing fungal debris, abscess drainage, paronychia incision, surgery for severe acne, debridement of burnt areas, and wart destruction. Instead, the service supplied should be represented by these medical procedures.
  • The physical therapist is responsible for billing for whirlpool therapy, using CPT codes 97597 and 97598, regardless of whether the whirlpool (97022) was delivered to a body part other than the body part receiving wound care therapy.
  • If the whirlpool (97022) is delivered for a body part other than the body part receiving wound care therapy, then separate billing of the whirlpool (97022) is permissible with 97597-97598.
  • It is not necessary that a physical therapist’s skill set was required to provide this therapy in the circumstances; however, if there are no skilled physicians on staff or in the region who can perform this procedure, then it must be billed at a higher rate (see CPT code 97597).

How often can CPT 11042 be billed?

Since CPT code 11042 is defined as “debridement, subcutaneous tissue” should be used if only necrotic tissue is debrided. So, even though the ulcer or wound might extend to the bone. In addition, if only fibrin is removed, this code would not be billed.

The frequency of billing for CPT 11042 depends on who is paying:

Patient’s insurance company: The patient’s insurance company may contract with a payer (such as Medicare) to pay for all visits covered by their plan. This type of contract is called a capitation agreement. In this situation, the patient’s insurance company pays a fixed amount they are responsible for covering per visit. The provider bills CPT 11042 at the same rate regardless of how many visits each provider bills on average.

Provider: If a patient has no contract with their insurance company and pays directly for their visits, then the provider can bill CPT 11042 at any time during the year (not just at service encounters).

ICD 10 code for wound care:

ICD-10 codes are associated with the L37228 wound care policy. With more specific documentation of diagnoses and procedures for billing and data tracking, the increased detail provided in the ICD 10 wound care coding system better accommodates new techniques and technologies, supporting outcomes, and reimbursement policies for medical interventions. Better data will serve providers and payors with essential information to guide disease management programs and reimbursement.

In short, Wound care claims are processed in much the same way as physician office visits. Hospitals, physical therapists, and other non-physician healthcare providers also bill on this basis; however, each must be contracted with your insurance companies before they can submit claims for reimbursement.

Benefits of wound care billing:

The benefits of this type of billing: 

It helps you get paid faster. For example, if you have a wound that will take a long time to heal, When you’re waiting for something, it can be aggravating. it to be covered by insurance, yet your insurer won’t pay the bill until it’s been open for more than 30 days. This can cause stress, anxiety, and depression in some patients.

It helps you gain control over your financial situation. By having accurate documentation of your wounds, you can ensure that the bills get paid on time so that you don’t have to worry about whether or not they will be delivered on time. You will also know how much money goes toward each wound and the associated expenses. This can help you budget better because you will know exactly how much money is available for other expenses like rent or car payments.

Reduce the amount of time:

It can help reduce the time needed to complete an examination or treatment plan. The more quickly you can get an accurate diagnosis, the less likely the patient will need additional tests or procedures. 

It makes the patient feel comfortable:

It helps patients feel more comfortable in receiving care from you because they know what is expected of them during their visit, what kind of results they can expect from what you do, and what the price will be overall (if applicable).

Immediate help for injuries:

You will receive immediate care for your injuries. The sooner you get treatment for your injury, the better it will be for you in the long run. Your doctor will be able to treat your injury quickly and effectively so that it does not become worse or spread further throughout your body.

Increased Patient Satisfaction:

One of the biggest advantages of employing a wound care billing company is that it can help improve patient satisfaction. After all, if you don’t feel like you’re getting the services you deserve or are being taken advantage of by your doctor or hospital, then it’s likely that they won’t be coming back. However, if they return and have high levels of satisfaction, then they’ll also refer others to your practice so that you can build up your patient base even more.


In short, when you bill for wound care, it’s essential to understand how these programs work. However, with the help of a medical billing expert, you can ensure your claims are being correctly submitted and processed. So, why waste time? Instead, hire U Control Billing for wound care billing, get the help of professionals in your work, and get things on time. 




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