Wound Care by RN on Unit
The question was raised to me today by my CNO because we are currently sending our PT/OT staff to provide wound care on the unit for our inpatient population rather than having our nurses do it. The question was if there was a difference in reimbursement from Medicare if the wound care was provided by an RN rather than a PT/OT. My only hesitation to this was that only Medicare QHPs can seek reimbursement from Medicare and RN aren't Medicare QHPs. Can you bill for wound care on your inpatient facility claim when the care is provided by a nurse and not a PT/OT? I know we will not receive any additional reimbursement because we are paid according to IPPS and our DRG is our reimbursement. I just want to ensure it is appropriate to bill for an RN performing the wound care provided physician's order, proper documentation, etc. is appropriate.
We charge for specialized wound care by our wound/ostomy nurses when it is ordered and provided at the bedside with an E/M charge based on mapping definitions for each level. If the wound care is provided by the bedside nurse as part of routine b/s care, we don't charge it separately. With all of that said, you are correct for IP claims in that the CPT is not reported and it will not be paid separately outside of a DRG or contracted flat rate by the payer. However, if your contracts allow for percentage of charge payment or outlier percentage of charge payment, it could impact your reimbursement. With all of that said, we do have some payers doing post-payment audits of our accounts that are requesting payment back if they define this as part of room/board care and not reimbursed separately.