How Coding Relates to Reimbursement for Wound Care Products and Treatments

By Glenda J. Motta, RN, BSN, MPH, ET 

What’s the relationship between coding and reimbursement? How are wound care products, services and technologies assigned codes, such as HCPCS (Healthcare Procedure Coding System)? What does this process entail? 

Reimbursement is a complex and often confusing subject. Asking the right questions, understanding the terminology and who and what is involved in determining reimbursement classification will help in better understanding what’s reimbursable and how the coding system works. 

This white paper explores reimbursement coding systems (i.e. HCPCS) relative to wound care products, services and technologies. 

How Coding Relates to Reimbursement for Wound Care Products and Treatments

What you will get out of this guide:

  • Information "checklist" for determining reimbursement of wound care products and treatments 
  • Level I and Level II Current Procedural Terminology (CPT®) definitions 
  • The role of agencies including the Center for Medicare & Medicaid (CMS) and the American Medical Association (AMA) 
  • The anatomy of the HCPCS code 
  • Assignment and review processes for product inclusion on the Pricing, Data Analysis and Coding Contractor (PDAC) Product Classification List