11042 and 97605

[andreasuemoore@hotmail.com]

We are getting denials for wound vac with debridement codes as "inclusive". Everything I find says 97605 has been unbundled. Hoping someone can point me in the right direction for more information on this. Thanks.

 

[TThivierge]

CPT 11042 and 97605 not paying

Hi Andrea,

Ah nope that will not work CPT codes 11042 and 97605. Read page 690 in the CPT manual 2018 on left bottom page .... the CPT code 97065 not mentioned but insurance company must think it is not payable. If a different area will cover, cannot be billed for same wound. Send the notes to the insurance company .But it says wound advice in CPT 97605 probably reason not covering it.

I hope this info helps you

Lady T

 

[andreasuemoore@hotmail.com]

CPT 11042 and 97605 not paying

Hi Andrea,

Ah nope that will not work CPT codes 11042 and 97605. Read page 690 in the CPT manual 2018 on left bottom page .... the CPT code 97065 not mentioned but insurance company must think it is not payable. If a different area will cover, cannot be billed for same wound. Send the notes to the insurance company .But it says wound advice in CPT 97605 probably reason not covering it.

I hope this info helps you

Lady T

Thank you Lady T!

 

[glcornett]

We are getting denials for wound vac with debridement codes as "inclusive". Everything I find says 97605 has been unbundled. Hoping someone can point me in the right direction for more information on this. Thanks.

Even though this response is a couple of years late , check your status indicators. 97605 has a status indicator of Q1 meaning reimbursement will be packaged with codes with status indicators S, T, or V (11042 has a status indicator of T).

 

[DRSZ1]

what about billing 97606 and 11042? does the same rule apply? If a different area will cover, cannot be billed for same wound.???