CMS Guidelines for Wound Care Medical Billing and Coding

The Centers for Medicare Medicaid Services (CMS) provide quite clear guidelines for accurate Wound Care Medical billing and coding. These guidelines are essential to ensure that healthcare providers receive proper reimbursement for the services they provide. As per guidelines, Wound care services are categorized into four basic classes based on severity. Each of these classes uses a different CPT code for claim reimbursements.

Superficial Wounds

This class of wound care deals with superficial wounds. These types of wounds only affect the skin’s outermost layer and do not damage inside body organs. These can specifically include minor abrasions, scratches, or skin tears. They generally do not extend beyond the epidermis and do not involve deeper tissues. In order to claim reimbursement against such wound care, medical professionals use the A6222 CPT Code.

Partial-Thick Wounds

This class of wound care deals with Partial thick wounds. These are the wounds that are more significant than superficial wounds. They involve damage to both the epidermis and part of the dermis. This category comes with stage two (2) pressure ulcers. These types of wounds extend into the deeper layers of the skin. In order to claim reimbursement against such damages, medical professionals use CPT code A6223.

Full Thickness Wounds

This class of wound care deals with Full thickness wounds. These are considered the severe category of wounds that involve the damage of the entire skin in comparison to the other two wounds. This includes damage to both the epidermis and dermis. Furthermore, the severity of this wound may extend even further to Stage 3 or 4 pressure ulcers. When a healthcare professional provides care facility against this wound, they usually use CPT Code A6224.

Deep Wounds

This wound care class deals with deep wounds that are the most severe of their type. For instance, such wounds can extend to the underlying structures like muscles and bones. In simple words, it can be said that these wounds come with pressure ulcers that reach all the way to the bone and complex surgical wounds. Such types of wounds are considered critical and require extensive treatment. Healthcare professionals can use CPT Code A6225 or provide treatment against deep wounds. Read More...