Aetna: Medical Maggots are Medically Necessary

In a clinical policy bulletin (CPB), Aetna clarifies its stance on the use of medical maggots for bio-surgery.

Aetna revised its policy May 8 to state that (effective Aug. 17, 2001) it considers  medical maggots medically necessary for the debridement of any of the following non-healing necrotic skin and soft tissue wounds:

  • Pressure ulcers
  • Venous stasis ulcers
  • Neuropathic foot ulcers
  • Non-healing traumatic or post surgical wounds

“During the 1930s, maggot debridement therapy (MDT) was used routinely for treating bone and soft-tissue infections,” Aetna states in the CPB. “Its use was supplanted by the introduction of new antibiotics and improvements in wound care. Recently, however, there has been a resurgence in the use of maggot therapy.”

Won’t your patients be thrilled?

“Medical maggots received 510(k) marketing clearance by the U.S. Food and Drug Administration (FDA) and are intended to debride non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or post surgical wounds,” continues the Aetna CPB.  “According to information submitted by the manufacturer to the FDA, the fly eggs are chemically disinfected before being placed in sterile vials for transport. The dressings used to confine them on the wound are called ‘Creature Comforts’ [one must have a sense of humor when dealing with maggots] and are designed to create a confining ‘cage dressing.’” They are applied directly to the wound surface in a dose of 5-8 maggots per square cm. The dressings are left in place on the wound for a ‘cycle’ of 48 hours (24-72 hours). One to 3 cycles are applied weekly. Most wounds require 2-6 cycles for complete debridement.”

How do you code for medical maggots? The CPB lists the following CPT®, HCPCS Level II, and ICD-9-CM codes:

CPT® Codes / HCPCS Codes / ICD-9 Codes
Medicinal leech therapy:
There is no specific CPT® code for medicinal leech therapy:
ICD-9 codes covered if selection criteria are met:
459.2 Compression of vein
459.81, 459.89 Venous (peripheral) insufficiency, unspecified, and other specified disorders of circulatory system
996.52 Mechanical complications due to graft of other tissue, not elsewhere classified
996.90 – 996.96 Complications of reattached extremity or body part
V49.60 – V49.77 Upper and lower limb amputation status
ICD-9 codes not covered for indications listed in the CPB:
042 Human immunodeficiency virus [HIV] disease
279.00 – 279.9 Disorders involving the immune mechanism
715.16, 715.26, 715.36, 715.96 Osteoarthrosis of knee, localized, primary or secondary, not specified whether primary or secondary, or unspecified whether generalized or localized
V08 Asymptomatic human immunodeficiency virus [HIV] infection status
Medical maggots:
CPT® codes covered if selection criteria are met:
97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session
ICD-9 codes covered if selection criteria are met:
249.80 – 249.81 Secondary diabetes mellitus with other specified manifestations
250.80 – 250.83 Diabetes with other specified manifestations
454.0 Varicose veins of lower extremities with ulcer
454.2 Varicose veins of lower extremities with ulcer and inflammation
707.00 – 707.9 Chronic ulcer of skin
872.10 – 897.7 Open wounds, complicated [non-healing]
998.83 Non-healing surgical wound

Want to learn more? Read the full CPB entitled “Bio-Surgery: Medicinal Leech Therapy and Medical Maggots.”

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