Wound Care Testing Matrix

Test No. / Test Description
MC01 / Debridement 1104X each additional without a debridement 1104X initial
MC02 / Debridement 97598 each additional without a debridement 97597 initial
MC03 / 1527X each additional without a 1527X initial
MC04 / Product application (1527X codes) and no Product; Product and no Application charge
OC01 / After the initial new E&M visit, only an established E&M can be billed
OC02 / UnnaBoot cannot be billed with: debridement open wound, debridement of the 1104X series, non-selective debridement and bio-skin application
OC03 / Multi-layer compression wrap cannot be billed with: debridement open wound, debridement of the 1104X series, non-selective debridement and bio-skin application
OC04 / Apligraf total units for date of services > 44 *may also test for discarded JW modifier if applicable
OC05 / Dermagraft total units for date of services > 38 *may also test for discarded JW modifier if applicable
OC06 / MatriStem total units for date of services > 60
OC07 / NPWT cannot be billed with debridement open wound or bio-skin application during the same visit unless performed at different site
OC08 / Total Contact Cast cannot be billed with debridement of the 1104X series and bio-skin application during the same visit unless performed at different site
OC09 / Skin Biopsy and debridement cannot be billed during the same visit unless performed at different site.
OC10 / Chemical cauterization of granulation tissue cannot be billed with debridement open wound, debridement of the 1104X series, non-selective debridement or NPWT during the same visit unless performed at different site.
OC11 / Only one 97602 can be billed per session
OC12 / 97602 cannot be billed on same visit as 97597 or 97598
OC13 / 15271 or 15272 cannot be billed when 15273 or 15274 CPTs are present
OC14 / 15275 or 15276 cannot be billed when 15277 or 15278 CPTs are present
OC15 / 97602 or 97597 or 97598 cannot be billed when 11042, 11043, 11044, 11045 or 11046 or 11047 CPTs are present
OT01 / 97598 (CPT) date of service quantities >= 4 units
OT02 / 1104X (CPT) date of service quantities >= 4 units
OT03 / Top 10 CDM by total $ charged during period
OT04 / Duplicate charges – EnctID, CDM_CPT, CDM_SrvDt
OT05 / HBO (CDM) review quantities > 4 or = 1
OT06 / Summary report – all debridement codes for audit period