You are 100% correct. FCSO's customer service rep read the exact same LCD but said they have an INTERNAL document contradicting the LCD. My situation was appealed to the Operations Department who feel that the internal document (which does not include OT) is correct. Apparently, the INTERNAL document is based on a Medical Policy decision which specifically states that OT is not reimbursable for wound care. I've written Medical Policy but it can take up to 4 weeks to get a reply.
Chuck, do you know what CMS' policy is on OT and wound care? Ron ----- Original Message ----- From: Charles Willmarth <[EMAIL PROTECTED]> Sent: Tuesday, November 08, 2005 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Florida Medicare Refused to Pay for OT to do Wound Care CW> Ron, CW> This doesn't make sense; the "FIRST COAST SERVICE OPTIONS CW> LOCAL COVERAGE DETERMINATION CODING GUIDELINES" (revised 1/1/05) state CW> that "Active wound care interventions as performend by physical CW> therapists, occupational therapists, and enterostomal therapy nurses are CW> reported by means of codes 97597 or 97598 and *97602." CW> Chuck CW> **************** CW> http://www.floridamedicare.com/parta_medcov_local_Debridement%20Services-01.asp CW> Selective debridement is reported with 97597 or 97598 and non-selective CW> with *97602. The provider performs wound care management to promote CW> healing using either selective or non-selective debridement techniques CW> to remove devitalized tissue. Active wound care interventions as CW> performend by physical therapists, occupational therapists, and CW> enterostomal therapy nurses are reported by means of codes 97597 or CW> 97598 and *97602. >>>> [EMAIL PROTECTED] 11/08/05 7:28 AM >>> CW> ============== Heads Up ================= CW> After many long conversations with my Medicare fiscal intermediary CW> (First Coast Service Options), they are refusing to pay for active wound CW> care simply because the procedure was provided by an OT. According to my CW> most recent conversations, effective January 1, 2005, wound care is only CW> covered if done by PT, it is not covered if done by OT. I have written CW> to Medical Policy Review but it does not look good. CW> ===================== CW> Ron CW> -- CW> Unsubscribe? CW> [EMAIL PROTECTED] CW> Change options? CW> www.otnow.com/mailman/options/otlist_otnow.com CW> Archive? CW> www.mail-archive.com/otlist@otnow.com CW> Help? CW> [EMAIL PROTECTED] -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Help? [EMAIL PROTECTED]
