Some of you have alerted me to new taxonomy codes that are relevant to the practice of wound care. This seems like huge news to me! I am listing a few of them below, with some explanation of what the components of the code mean. I do not know, for example, if an internist is NOT a rehabilitation specialist, or if an orthopedic surgeon is not practicing sports medicine – if they can use the codes designated for those specialties. I certainly do not know who spearheaded these new codes although I’d like to know! If you have insider knowledge about these new taxonomy codes and can help us understand them – please contact me!
What is a Taxonomy Code?
A taxonomy code is a unique 10-character code that designates practitioner (physician or nurse practitioner) classification and specialization. Practitioners use this code when applying for a National Provider Identifier (NPI), which is needed to bill Medicare. (Applications for NPIs are processed through the National Plan & Provider Enumeration System, or NPPES.) Clinicians are supposed to use the taxonomy code that most closely describes their provider type, classification, or specialization. I do not know of any regulations that require a practitioner to be board certified in the specialty represented by the taxonomy code they have chosen.
Here are the Wound Care Taxonomy Codes:
Family Medicine with a Wound Care Specialty: 207QG0300X
- 207: This indicates the primary specialty, which is Family Medicine.
- QG: This code identifies the sub-specialty or specialization. In this case, “QG” refers to Wound Care, signifying the physician’s additional focus within Family Medicine on wound management and care.
- 0300: This code is used to further define the provider classification. “0300” refers to the specific level or categorization of the Wound Care specialty.
- X: The “X” indicates that this taxonomy code is assigned to an individual provider, not a group or facility.
Undersea and Hyperbaric Medicine: 2081P0011X
- 2081: This part represents the primary specialty, which is Undersea and Hyperbaric Medicine.
- P: The “P” indicates a specialization within this field, such as those who are specifically trained in hyperbaric medicine.
- 0011: This component specifies the provider classification, identifying the level or category of specialization.
- X: The “X” at the end signifies that this code applies to an individual provider.
Internal Medicine with a Wound Care Specialty: 207RG0300X
- 207: The primary specialty is Internal Medicine
- RG: “RG” indicates a Wound Care subspecialty
- 0300: This part specifies the provider classification for the wound care specialty, identifying the classification or specific subset of wound care that the physician practices.
- X: The “X” shows that this taxonomy code is for an individual provider.
Emergency Medicine with a Wound Care Specialty: 207PE0005X
- 207: The primary specialty is Emergency Medicine
- PE: “PE” indicates a Wound Care subspecialty within emergency medicine.
- 0005: This part defines the provider classification in the context of wound care within emergency medicine.
- X: The “X” signifies an individual provider.
General Surgery (Wound Care Specialty): 2086S0105X
- 2086: The primary specialty is Orthopedic Surgery.
- S: The “S” represents the specialization within that primary specialty. In this case, “S” stands for Sports Medicine, which indicates the physician focuses on sports-related injuries and physical performance.
- 0105: This part is the provider’s classification under a specific specialization and is unique to the field. The “0105” represents Orthopedic Surgery of the Spine, suggesting the physician specializes in treating conditions related to the spine.
- X: The “X” at the end indicates the provider type, which in this case is typically used for individual providers (as opposed to a group practice or institution).
Summary of Key Points:
- 207: Primary specialty code for various fields (Family Medicine, Internal Medicine, Emergency Medicine, etc.).
- QG, RG, PE: Indicates the subspecialty within each primary field. “QG” and “RG” relate to Wound Care, while “PE” refers to wound care in the context of Emergency Medicine.
- 0300, 0300, 0005: These are the provider classification codes, detailing the specific category of the subspecialty (e.g., wound care).
- X: Denotes the code applies to an individual provider.
Why Should You Care About These Taxonomy Codes?
Being able to be recognized as a wound care practitioner would help a lot with the issue of cost attribution. I have blogged extensively about the serious problems we found in the development of the “non-pressure ulcer” cost measure. It was apparent in the process of field testing that the measure developer believed, for example, that a family practitioner with data on wound care patients was just seeing the occasional wound care patient. They didn’t understand that it could be practiced full time. This would mean that every wound care practitioner would end up in a subgroup by primary specialty when CMS looks at their overall patient charges which is frankly, silly. (For information about these problems, read Quick Guide to Reviewing Your Medicare Field Test Report).
However, there’s a bigger issue. Some specialties are exempt from the assignment of a cost measure. Undersea and Hyperbaric Medicine is one of those. In other words, if you are a hyperbaric medicine practitioner (the definition of which includes wound care) CMS will not apply any cost measures to your practice. If CMS eventually moves forward with a badly designed cost measure which holds one wound care practitioner responsible for charges actually billed by another practitioner (such as excessive use of skin substitutes) – hyperbaric medicine doctors won’t be impacted. I changed my taxonomy to hyperbaric medicine as soon as that code became available, simply to ensure that I would no longer be held responsible for the rehospitalization rates of all my wound care patients with heart failure!
If you want to understand the bigger picture of cost measures and the Quality Payment Program, here’s a blog for a sleepless night: The Quality Payment Program and What it Means for the Future of Wound Management & HBOT – Caroline Fife M.D.
Useful links:
- Healthcare Provider Taxonomy Codes. View the complete dataset on data.cms.gov, where you can select various download formats to view the entire list.
- National Uniform Claim Committee (NUCC) code set list.
- Find Your Taxonomy Code | CMS
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
