General Surgery Coding Alert

Not all wound care codes are limited to NPPs

Although negative-pressure therapy, or vacuum-assisted drainage collection (often shortened to VAC or VAD) -- which allows physicians to treat patients with diabetic pressure ulcers or other sores without debriding tissue -- has become an increasingly popular treatment option, coding remains something of a mystery. Here are three quick and easy steps to bring you up to speed.

Step 1. Document Surface-Area Measurements

To apply codes 97605 (Negative-pressure wound therapy [e.g., vacuum-assisted drainage collection], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session; total wound[s] surface area less than or equal to 50 square centimeters) and 97606 (... total wound[s] surface area greater than 50 square centimeters) appropriately, you must have documentation that specifies the surface area of the wound the physician treated.

Namely, if the provider performs and documents VAD on a wound that's less than or equal to 50 square centimeters, you should report 97605. But if the wound is greater than 50 square centimeters, you should report 97606, says Suzan Hvizdash, BS, CPC, CPC-EMS, CPC-EDS, physician educator for the University of Pittsburgh and past member of the AAPC national advisory board.

Documentation tip: To ensure you code VAD with confidence, educate your physician about including the wound's measurements in the documentation. That way, you can simply look for the size and link it with the correct code, Hvizdash says.

VAC codes are open to physicians: Although CPT specifically states that nonphysician practitioners can use wound care codes 97597-97602 (Removal of devitalized tissue from wound[s], ... debridement, without anesthesia ...), physicians can report 97605-97606 as well.

Step 2. Watch Out for Dx Limitations

You-ll have to be careful with your diagnosis: Local Part B payers vary in the exact diagnoses they will allow to support a 97605 or 97606 claim, but a typical policy makes clear that VAC will be covered -as an adjunct to standard treatment in carefully selected patients who have failed all other forms of treatment.-

Generally accepted -indications of use- include (but are not limited to):

--chronic stage III or IV pressure ulcers
--neuropathic ulcers
--venous or arterial insufficiency ulcers
--chronic ulcers of mixed etiology present for at least 30 days
--dehisced wounds or wounds with exposed orthopedic hardware or bone
--acute wounds
--poststernotomy mediastinitis.

Contraindications for 97605-97606 coverage typically include (but are not limited to):

--necrotic tissue with eschar in the wound, if debridement is not attempted
--untreated osteomyelitis within the vicinity of the wound
--cancer in the wound
--a fistula to an organ or body cavity within the wound's vicinity.

Depth may matter: Although CPT guidelines mention nothing about wound depth, you shouldn't overlook this.

-Depth is probably one of the most important aspects of establishing the length of time a person would need the VAC closure. Certainly, if a wound covered a large area of the anatomy, that plays a role. However, if the wound is smaller, but deeper, that will also impact the necessity of the VAC,- Hvizdash says.

Most payers- local coverage determinations (LCDs) stipulate that they will continue to provide coverage for up to four months, until adequate wound healing has occurred or when documentation shows that a measurable degree of wound healing has failed to occur over the prior month (whichever comes first).

A must: Contact your local carrier for a complete list of covered ICD-9 codes.

Remember: You must report a diagnosis supported by clinical evidence. You should not select a diagnosis merely to obtain coverage, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.

Step 3. Keep an Eye Open for Bundles

Even if you meet all the requirements for reporting 97605-97606, you may still find the services bundled to other procedures the physician provides, Hammer says.

The National Correct Coding Initiative (NCCI) applies hundreds of edits to 97605-97606, bundling the services to procedures such as debridements, burn treatments, lesion destruction, and amputation, among others.

Always check: Before reporting 97605-97606 with any other services, be sure to check the NCCI to be sure it doesn't bundle the codes.

The NCCI allows you to use a modifier (such as modifier 59, Distinct procedural service) to override most of these edits. The provider's documentation, however, must support the use of the modifier.

For example, if 'the VAC wound care is in a separate anatomical location (for instance, on the lower leg) from a wound debridement on the upper extremity, you would be compliant in appending modifier 59 to 97605-97606 and bypassing the bundling edit, Hammer says.

Bottom line: In many cases that your practice might provide negative-pressure wound therapy, you-ll probably find that NCCI bundles the service into other procedures the physician provides because your surgeon performed it at the same location during the same session.