In 2010, Alberta Health changed its pricing for debridement procedures so that a functional area receives a higher rate than a non-functional area.
A recent WCB-Alberta audit of debridement billings revealed that some physicians are using the code for a non-functional area when it is a functional area that was treated. This creates an under-payment for these physicians.
Alberta Health’s Schedule of Medical Benefits Procedure List now states that a debridement of a wound or infected tissue can be claimed once per functional or non-functional anatomical area as defined in rules 7.1.1 and 7.1.2 with the exception of paired structures, which may be claimed as two anatomical areas.
Here are the definitions of the two rules:
- 7.1.1 Functional Area
Functional area includes the following anatomical areas: head, face, neck, shoulder, axilla, elbow, wrist, hand, groin, perineum, knee, ankle and foot, and includes coverage of exposed vital structures (bone, tendon, major vessel, nerve). - 7.1.2 Non-functional Area
Non-functional area includes the following anatomical areas: posterior trunk, anterior trunk, arm (above elbow), forearm (below elbow), thigh and leg (below knee).
For more advice from AMA staff on any billing issues, please email AMA billing staff or visit Billing help page on the AMA website.