Who We Serve
Our wound care billing services support a wide range of healthcare providers:
- wound care centers
- hospitals and health systems
- podiatry practices
- dermatology clinics
- vascular surgery groups
- home health agencies
- outpatient specialty clinics
Whether you operate a dedicated wound care center or provide wound treatment as part of a specialty practice, our billing team helps optimize your revenue cycle.
Key Components of Our Wound Care Billing Process
Clinical Documentation Capture
Wound Surface Area Calculation
Depth-Based Debridement Coding
Procedure–Diagnosis Code Alignment
Advanced Therapy Coding
Wound-Specific Claim Scrubbing
Medicare & Payer Policy Compliance
Electronic Claim Submission
Denial Investigation & Appeals
Revenue Cycle Performance Analytics
What Sets Us Apart From Other Wound Care Billing Companies
Protect Your Practice From Medicare Audits
Wound care billing is frequently audited by Medicare and federal contractors such as RAC (Recovery Audit Contractors), UPIC (Unified Program Integrity Contractors), and MAC review teams, especially for services like debridement and skin substitutes.
Our team reviews your documentation, coding, and billing practices to determine whether your practice is prepared for these audits and identifies gaps before auditors do.
Built for the Unique Demands of Wound Care Billing
Payer Problems? Not Yours Anymore
Our team works directly with insurers to verify wound care coverage and prevent claim denials.
Wound Care Billing Experts On Call
Get help with coding, documentation, and billing questions from specialists who understand wound care.
We Work With Your Existing Systems
Supporting 600+ systems including Epic, Cerner, Athenahealth, eClinicalWorks, NextGen, Kareo, AdvancedMD, and more.
Get a FREE audit of your claims, coding, and documentation.
We assess your current billing and suggest ways to improve it. There is no sales pitch and no obligation. The decision to continue is completely yours.
Operational Efficiency With Measurable Financial Performance
Wound Care Procedures We Bill
Our billing specialists support a wide range of wound care treatments.
Chronic Wound Management
- Diabetic foot ulcers
- Venous ulcers
- Arterial ulcers
- Pressure injuries
Advanced Therapies
- Surgical debridement
- Skin grafts and substitutes
- Hyperbaric oxygen therapy
- Negative pressure wound therapy
Acute & Surgical Wounds
- Burn wounds
- Post-surgical wounds
- Traumatic injuries
- Infected wounds
Wound care billing must adhere to strict payer regulations and documentation standards.
Our compliance framework ensures alignment with:
- Medicare and Medicaid billing guidelines
- Commercial payer policies
- CMS documentation standards
- HIPAA data security requirements
- Medical necessity documentation rules
We Only Get Paid When You Get Paid
Our wound care billing services are built around a performance-based model, which means our success is directly tied to the revenue we generate for your practice.
Our pricing is simple and transparent. We operate on a percentage-based model, so you only pay a small portion of the collections we help bring in.
What this means for your practice
- Up to 50% reduction in overhead costs
- Up to 45% faster reduction in A/R
- Average 96% net collection rate
- Up to 15–35% improvement in overall revenue
Frequently Asked Questions
The most common CPT codes for wound debridement include:
- 97597 – selective debridement up to 20 cm²
- 97598 – additional 20 cm²
- 11042–11047 – surgical debridement depending on tissue depth
These codes are selected based on the deepest tissue removed and total surface area treated, not just wound type.
Medicare reimburses wound care based on:
- CPT procedure codes
- ICD-10 diagnosis codes
- Documentation supporting medical necessity
- Local Coverage Determinations (LCDs)
Claims must link the appropriate ICD-10 diagnosis to the procedure performed for payment approval.
Common reasons include:
- Missing wound measurements
- Incorrect CPT code selection
- Insufficient documentation of medical necessity
- Modifier errors
- Bundling violations
Documentation deficiencies are the most frequent cause of denial.
Documentation must include:
- Wound size and measurements
- Tissue depth involved
- Location of the wound
- Type of treatment performed
- Medical necessity justification
Clear documentation supports both coding accuracy and compliance.
The difference lies in the depth of tissue removed.
- 97597 – selective removal of devitalized tissue
- 11042 – surgical debridement including subcutaneous tissue
Surgical codes require more extensive tissue removal using instruments.
Yes. An E/M visit may be billed with wound procedures if it represents a separately identifiable service. Modifier -25 is typically required.
Modifiers provide additional context for claims. Common wound care modifiers include:
- -25 – separate E/M service
- -59 – distinct procedural service
- LT / RT – left or right side of body
Incorrect modifier usage can trigger claim denials.
Surface area is calculated by multiplying:
length × width (in centimeters)
This determines whether add-on codes are required for larger wounds.
Common diagnosis codes include:
- Diabetic foot ulcers
- Pressure ulcers
- Venous ulcers
- Traumatic wounds
- Surgical wound complications
Accurate diagnosis coding is necessary to prove medical necessity.
Frequency depends on:
- Clinical necessity
- Wound progression
- Payer guidelines
Medicare may audit claims when debridement occurs repeatedly without evidence of healing progress.
Selective debridement removes devitalized tissue only, preserving healthy tissue.
This procedure is billed using CPT codes 97597–97598.
Surgical debridement involves removal of tissue using surgical instruments such as scalpels or curettes. It is billed using CPT codes 11042–11047 depending on tissue depth.
Complex wounds include:
- Diabetic foot ulcers
- Venous leg ulcers
- Pressure injuries
- Surgical wounds
- Traumatic wounds
Chronic wounds require extensive documentation and careful coding.
Negative pressure wound therapy (NPWT) uses suction devices to accelerate wound healing. Common CPT codes include:
- 97605 – wounds ≤50 cm²
- 97606 – wounds >50 cm²
Yes. Skin substitute procedures require:
- CPT procedure codes
- HCPCS product codes for the graft material
Because of:
- High treatment costs
- Complex coding rules
- Frequent Medicare audits
Incorrect coding can result in compliance issues.
ICD-10 codes explain why the procedure was medically necessary. Without correct diagnosis codes, claims may be rejected.
Common mistakes include:
- Incorrect tissue depth coding
- Incorrect wound measurement
- Missing modifiers
- Mismatched CPT and ICD-10 codes
Yes. Therapists may bill certain procedures when acting within their licensed scope of practice.
What payers cover wound care services?
Most wound care treatments are covered by:
- Medicare
- Medicaid
- Commercial insurance
- Workers compensation
Coverage depends on medical necessity.
Strong documentation supports:
- Medical necessity
- Procedural accuracy
- Payer compliance
Without it, even correctly coded claims may be denied.