Test No. Test Description



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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


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