Wiki Application of Wound Vac - Patient had an I&D and wound

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
G
Code: K62.89

Code Name: ICD-10 Code for Other specified diseases of anus and rectum

Block: Other diseases of intestines (K55-K64)

Details: Other specified diseases of anus and rectum
Proctitis NOS

Use additional code for any associated fecal incontinence (R15.-)
K62.8

Excludes2: ulcerative proctitis (K51.2)

K62

Includes: anal canal

Excludes2: colostomy and enterostomy malfunction (K94.0-, K94.1-)
fecal incontinence (R15.-)
hemorrhoids (K64.-)

Guidelines: Diseases of the digestive system (K00-K95)

Excludes 2: certain conditions originating in the perinatal period (P04-P96)
certain infectious and parasitic diseases (A00-B99)
complications of pregnancy, childbirth and the puerperium (O00-O9A)
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
endocrine, nutritional and metabolic diseases (E00-E88)
injury, poisoning and certain other consequences of external causes (S00-T88)
neoplasms (C00-D49)
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

For more details on K62.89, ICD-10 Code for Other specified diseases of anus and rectum , visit: https://coder.aapc.com/icd-10-codes/
Messages
145
Best answers
0
Patient had an I&D and wound vac application to the right hindfoot due to infection.

Medicare is denying the wound vac charge.

I billed 27603, 97605-59.

Is there anything else I can do?
 
Messages
145
Best answers
0
It was actually because of the diagnosis. I used 682.6, which I thought was payable for this.

I just need to different diagnosis for the use of the wound vac.

Any ideas?
 

Bella Cullen

Guest
Messages
499
Best answers
0
Here is a list of CPT codes and Diagnoses that are medically necessary for those CPT codes from the Medicare website, Hope you can use one of those DX's.
:)


CPT/HCPCS Codes back to top
Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes.

See revision history for code updates effective 01/01/2009.
11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
11001 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
11040 DEBRIDEMENT; SKIN, PARTIAL THICKNESS
11041 DEBRIDEMENT; SKIN, FULL THICKNESS
11042 DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE
11043 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE
11044 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE
29580 STRAPPING; UNNA BOOT
97022 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; WHIRLPOOL
97597 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), WITH OR WITHOUT TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, MAY INCLUDE USE OF A WHIRLPOOL, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 20 SQUARE CENTIMETERS
97598 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), WITH OR WITHOUT TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, MAY INCLUDE USE OF A WHIRLPOOL, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 20 SQUARE CENTIMETERS
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
97605 NEGATIVE PRESSURE WOUND THERAPY (EG, 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
97606 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS



ICD-9 Codes that Support Medical Necessity back to top
It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
017.00 - 017.06 TUBERCULOSIS OF SKIN AND SUBCUTANEOUS CELLULAR TISSUE UNSPECIFIED EXAMINATION - TUBERCULOSIS OF SKIN AND SUBCUTANEOUS CELLULAR TISSUE TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)
021.0 ULCEROGLANDULAR TULAREMIA
022.0 CUTANEOUS ANTHRAX
024 GLANDERS
031.1 CUTANEOUS DISEASES DUE TO OTHER MYCOBACTERIA
039.0 - 039.9 CUTANEOUS ACTINOMYCOTIC INFECTION - ACTINOMYCOTIC INFECTION OF UNSPECIFIED SITE
040.0 GAS GANGRENE
085.1 - 085.5 CUTANEOUS LEISHMANIASIS URBAN - MUCOCUTANEOUS LEISHMANIASIS (AMERICAN)
110.0 DERMATOPHYTOSIS OF SCALP AND BEARD
110.2 - 110.9 DERMATOPHYTOSIS OF HAND - DERMATOPHYTOSIS OF UNSPECIFIED SITE
116.0 - 116.2 BLASTOMYCOSIS - LOBOMYCOSIS
172.0 - 172.8 MALIGNANT MELANOMA OF SKIN OF LIP - MALIGNANT MELANOMA OF OTHER SPECIFIED SITES OF SKIN
173.0 - 173.8 OTHER MALIGNANT NEOPLASM OF SKIN OF LIP - OTHER MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF SKIN
174.0 - 174.9 MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF BREAST (FEMALE) UNSPECIFIED SITE
175.0 MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF MALE BREAST
176.0 KAPOSI'S SARCOMA SKIN
198.2 SECONDARY MALIGNANT NEOPLASM OF SKIN
216.0 - 216.8 BENIGN NEOPLASM OF SKIN OF LIP - BENIGN NEOPLASM OF OTHER SPECIFIED SITES OF SKIN
232.0 - 232.8 CARCINOMA IN SITU OF SKIN OF LIP - CARCINOMA IN SITU OF OTHER SPECIFIED SITES OF SKIN
233.0 CARCINOMA IN SITU OF BREAST
249.70 - 249.71 SECONDARY DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISORDERS, NOT STATED AS UNCONTROLLED, OR UNSPECIFIED - SECONDARY DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISORDERS, UNCONTROLLED
250.80 - 250.83 DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED
440.23 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH ULCERATION
440.24 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH GANGRENE
443.1 THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE)
454.0 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER
454.2 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER AND INFLAMMATION
459.11 POSTPHLEBETIC SYNDROME WITH ULCER
459.13 POSTPHLEBETIC SYNDROME WITH ULCER AND INFLAMMATION
459.31 CHRONIC VENOUS HYPERTENSION WITH ULCER
459.33 CHRONIC VENOUS HYPERTENSION WITH ULCER AND INFLAMMATION
565.0 - 565.1 ANAL FISSURE - ANAL FISTULA
566 ABSCESS OF ANAL AND RECTAL REGIONS
608.4 OTHER INFLAMMATORY DISORDERS OF MALE GENITAL ORGANS
608.83 VASCULAR DISORDERS OF MALE GENITAL ORGANS
611.0 INFLAMMATORY DISEASE OF BREAST
616.4 OTHER ABSCESS OF VULVA
616.50 - 616.51 ULCERATION OF VULVA UNSPECIFIED - ULCERATION OF VULVA IN DISEASES CLASSIFIED ELSEWHERE
619.2 GENITAL TRACT-SKIN FISTULA FEMALE
619.8 OTHER SPECIFIED FISTULAS INVOLVING FEMALE GENITAL TRACT
664.00 - 664.44 FIRST-DEGREE PERINEAL LACERATION UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - UNSPECIFIED PERINEAL LACERATION POSTPARTUM
674.10 - 674.14 DISRUPTION OF CESAREAN WOUND UNSPECIFIED AS TO EPISODE OF CARE - DISRUPTION OF CESAREAN WOUND POSTPARTUM
674.20 - 674.24 DISRUPTION OF PERINEAL WOUND UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - DISRUPTION OF OBSTETRICAL PERINEAL WOUND POSTPARTUM
674.30 - 674.34 OTHER COMPLICATIONS OF OBSTETRICAL SURGICAL WOUNDS UNSPECIFIED AS TO EPISODE OF CARE - OTHER COMPLICATIONS OF OBSTETRICAL SURGICAL WOUNDS POSTPARTUM CONDITION OR COMPLICATION
681.00 UNSPECIFIED CELLULITIS AND ABSCESS OF FINGER
681.10 UNSPECIFIED CELLULITIS AND ABSCESS OF TOE
682.0 - 682.9 CELLULITIS AND ABSCESS OF FACE - CELLULITIS AND ABSCESS OF UNSPECIFIED SITES
686.09 OTHER PYODERMA
686.9 UNSPECIFIED LOCAL INFECTION OF SKIN AND SUBCUTANEOUS TISSUE
705.83 HIDRADENITIS
707.00 - 707.9 PRESSURE ULCER, UNSPECIFIED SITE - CHRONIC ULCER OF UNSPECIFIED SITE
709.8 OTHER SPECIFIED DISORDERS OF SKIN
728.86 NECROTIZING FASCIITIS
730.00 - 730.20 ACUTE OSTEOMYELITIS SITE UNSPECIFIED - UNSPECIFIED OSTEOMYELITIS SITE UNSPECIFIED
785.4 GANGRENE
870.0 - 870.2 LACERATION OF SKIN OF EYELID AND PERIOCULAR AREA - LACERATION OF EYELID INVOLVING LACRIMAL PASSAGES
872.01 OPEN WOUND OF AURICLE UNCOMPLICATED
872.11 OPEN WOUND OF AURICLE COMPLICATED
873.0 OPEN WOUND OF SCALP WITHOUT COMPLICATION
873.1 OPEN WOUND OF SCALP COMPLICATED
873.20 - 873.22 OPEN WOUND OF NOSE UNSPECIFIED SITE UNCOMPLICATED - OPEN WOUND OF NASAL CAVITY UNCOMPLICATED
873.32 - 873.33 OPEN WOUND OF NASAL CAVITY COMPLICATED - OPEN WOUND OF NASAL SINUS COMPLICATED
873.41 - 873.49 OPEN WOUND OF CHEEK UNCOMPLICATED - OPEN WOUND OF OTHER AND MULTIPLE SITES UNCOMPLICATED
873.51 - 873.59 OPEN WOUND OF CHEEK COMPLICATED - OPEN WOUND OF OTHER AND MULTIPLE SITES COMPLICATED
874.8 - 874.9 OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF NECK WITHOUT COMPLICATION - OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF NECK COMPLICATED
875.0 - 875.1 OPEN WOUND OF CHEST (WALL) WITHOUT COMPLICATION - OPEN WOUND OF CHEST (WALL) COMPLICATED
876.0 - 876.1 OPEN WOUND OF BACK WITHOUT COMPLICATION - OPEN WOUND OF BACK COMPLICATED
877.0 - 877.1 OPEN WOUND OF BUTTOCK WITHOUT COMPLICATION - OPEN WOUND OF BUTTOCK COMPLICATED
878.0 - 878.9 OPEN WOUND OF PENIS WITHOUT COMPLICATION - OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF GENITAL ORGANS COMPLICATED
879.0 - 879.9 OPEN WOUND OF BREAST WITHOUT COMPLICATION - OPEN WOUND(S) (MULTIPLE) OF UNSPECIFIED SITE(S) COMPLICATED
880.00 - 880.29 OPEN WOUND OF SHOULDER REGION WITHOUT COMPLICATION - OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM WITH TENDON INVOLVEMENT
881.00 - 881.22 OPEN WOUND OF FOREARM WITHOUT COMPLICATION - OPEN WOUND OF WRIST WITH TENDON INVOLVEMENT
882.0 - 882.2 OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITHOUT COMPLICATION - OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITH TENDON INVOLVEMENT
883.0 - 883.2 OPEN WOUND OF FINGERS WITHOUT COMPLICATION - OPEN WOUND OF FINGERS WITH TENDON INVOLVEMENT
884.0 - 884.2 MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITHOUT COMPLICATION - MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITH TENDON INVOLVEMENT
885.0 - 885.1 TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) COMPLICATED
886.0 - 886.1 TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) COMPLICATED
887.0 - 887.7 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL BELOW ELBOW WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED
890.0 - 890.2 OPEN WOUND OF HIP AND THIGH WITHOUT COMPLICATION - OPEN WOUND OF HIP AND THIGH WITH TENDON INVOLVEMENT
891.0 - 891.2 OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE WITHOUT COMPLICATION - OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE WITH TENDON INVOLVEMENT
892.0 - 892.2 OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE WITHOUT COMPLICATION - OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE WITH TENDON INVOLVEMENT
893.0 - 893.2 OPEN WOUND OF TOE(S) WITHOUT COMPLICATION - OPEN WOUND OF TOE(S) WITH TENDON INVOLVEMENT
894.0 - 894.2 MULTIPLE AND UNSPECIFIED OPEN WOUND OF LOWER LIMB WITHOUT COMPLICATION - MULTIPLE AND UNSPECIFIED OPEN WOUND OF LOWER LIMB WITH TENDON INVOLVEMENT
895.0 - 895.1 TRAUMATIC AMPUTATION OF TOE(S) (COMPLETE) (PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF TOE(S) (COMPLETE) (PARTIAL) COMPLICATED
896.0 - 896.3 TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) UNILATERAL WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) BILATERAL COMPLICATED
897.0 - 897.7 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL BELOW KNEE WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED
997.60 UNSPECIFIED LATE COMPLICATION OF AMPUTATION STUMP
997.62 INFECTION (CHRONIC) OF AMPUTATION STUMP
997.69 OTHER LATE AMPUTATION STUMP COMPLICATION
998.30 - 998.33 DISRUPTION OF WOUND, UNSPECIFIED - DISRUPTION OF TRAUMATIC INJURY WOUND REPAIR
998.51 - 998.59 INFECTED POSTOPERATIVE SEROMA - OTHER POSTOPERATIVE INFECTION
998.6 PERSISTENT POSTOPERATIVE FISTULA NOT ELSEWHERE CLASSIFIED
998.83 NON-HEALING SURGICAL WOUND
 

Bella Cullen

Guest
Messages
499
Best answers
0
I just noticed 682.6 dx is on the list for covered dx's. What state are you in because that might make a difference. Then I can pull that list for your state.
 

Frosty

Networker
Messages
71
Best answers
0
I am questioning the use of a wound vac code at all for physician charges. I have not done any investigation of this since March of '08, but at that time I found a thread in our forum something like "Can you bill for wound vac w/ I&D procedure?" Someone cited the CPT assistant --June 2005 page 9-11 that had the following:
Medicine: Active wound Care Management
Question: Is it appropriate for physicians to report codes from the active wound care management series 97597-97606?
AMA Comment: Codes in the active wound care management series provide a mechanism for reporting interventions associated with active wound care as performed by licensed nonphysician professionals. These codes are to be reported by nonphysician professionals (eg, physician assistants, nurse practitioners, enterostomal therapy nurses, wound care nurses, physical therapists) licensed to perform these procedures. Only those individuals licensed by a particular state to perform the described services should use the codes to report services. As licensure varies from state to state, the applicable state laws and requirements determine who may perform specific types of services. for wound debridement performed by physicians, see codes 11040-11044.
(back to me) - I don't know if this is old and doesn't apply anymore, maybe someone else can shed some light? Also, I wouldn't think a mod 59 would be appropriate since you're applying the wound vac to the same wound that had an I&D. Anybody?
 

Bella Cullen

Guest
Messages
499
Best answers
0
An article from the AAOS March O8 says append modifier 59 if necessary when billing with another procedure, and I used to bill 97605-59 for podiatrists with an I&D.

Here is what it says from the article:
Q: We just learned that we can report the application of a wound vacuum dressing. What codes do we use?

A: Negative-pressure wound therapy is reportable when the documentation supports the service. In 2007, the AAOS updated the Global Service Data for Orthopaedic Surgery book to classify this as an “excluded service” for all musculoskeletal and integumentary codes. The following verbiage is in the “Intraoperative services not included in the global surgical package” section of Global Service Data:“2. complicated wound closure (eg, application of wound vacuum device to open wound) or closure requiring local or distant flap coverage and/or skin graft, when appropriate (eg, 13160, 14000-14350, 15000-15400, 15570-15776)”

CPT codes 97605 (Negative pressure wound therapy (eg, 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 (Negative pressure wound therapy (eg, vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters) describe the services; it may be necessary to append modifier 59 to indicate a distinct procedure if other services are reported at the same session.
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
I think the AAOS comment is being misunderstood.

Orthopedic Coder's Pink Sheet
Effective Date 09/01/2007
Publish Date September 2007
"Question:Can PHYSICIANs bill for negative pressure wound therapy codes
97605 and 97606?

Answer: Not according to CPT. The WOUND VAC codes are part of the active wound care management series, which “provide a mechanism for reporting interventions associated with active wound care as performed by licensed nonPHYSICIAN professionals” (CPT Assistant, June 2005).

“These codes are to be reported by nonPHYSICIAN professionals (e.g., PHYSICIAN assistants, nurse practitioners, enterostomal therapy nurses, wound care nurses, physical therapists) licensed to perform these procedures,” CPT says. Further, CPT tells you to check your state laws for licensure requirements and restrictions on who may perform specific types of services.
PHYSICIANs should refer to the surgical debridement codes, 11040-11044 , CPT directs.

That should take care of some of the confusion generated by a parenthetical note in the CPT manual that tells you not to report codes 97597-97602 with 11040-11044, with no mention of whether the restriction also applied to the WOUND VAC codes, 97605 and 97606. Now, with the June 2005 CPT Assistant, we see that the AMA's intent is that PHYSICIANs not bill these codes.

Medicare may be different: You'll have to keep a close eye on your Medicare local coverage determination for its specific wound care billing policy.
Medicare added work RVUs for the WOUND VAC codes in the 2006 PHYSICIAN fee schedule (Nov. 21, 2005 Federal Register). This year, for 97605, Medicare pays $33. For 97606 it pays $35.62 (both fees in the office setting, par, not adjusted for locality). Coverage, however, is tightly restricted:

“When the negative pressure wound therapy service does not encompass selective debridement, we consider the service to represent a dressing change and will not make separate payment,” CMS states in the 2006 Medicare fee schedule.
“When the negative pressure wound therapy service includes the need for selective debridement, we consider the services represented by CPT codes
97605 and 97606 to be bundled into CPT codes 97597 and 97598, meaning that we would not make separate payment for these services.” (2006 Medicare PHYSICIAN fee schedule) Still, starting last year, Medicare changed the status for 97605 and 97606 from “bundled” to “active” in the PHYSICIAN fee schedule relative value file. Also, in April 2006, Medicare introduced CCI edits bundling the WOUND VAC codes as components of 11040-11044, but it later removed them, retroactive to April 1, 2006 .

Resources

Download the 2006 Medicare PHYSICIAN fee schedule payment policy for negative pressure wound therapy from the Nov. 21, 2005 Federal Register at:
www.access.gpo.gov/su_docs/fedreg/a051121c.html
 

Bella Cullen

Guest
Messages
499
Best answers
0
http://www.aaos.org/news/aaosnow/mar08/managing1.asp

http://www.karenzupko.com/downloads/article_MLG_0308 - Frequently asked coding questions AAOS Now MARCH08.pdf

Here are the links that says what I wrote from AAOS March 2008 article.
It says right there under 97605 that it may be
necessary to append modifier 59 to indicate a distinct procedure if other services are reported
at the same session.


This is to answer if physicians can bill for wound vac. It says yes they can.
http://www.kci1.com/88.asp
6. Is there currently a CPT code that can be used to bill for application of V.A.C.® Dressings?

Effective January 1, 2005, Negative Pressure Wound Therapy (NPWT) was assigned two CPT codes for wound treatment by the American Medical Association (AMA):

CPT Code
Wound Size

97605
< or = 50 cm2 in surface area

97606
> 50 cm2 in surface area


CMS changed the payment status in the 2006 Medicare Physician Fee schedule to "A" (active status) for the NPWT CPT codes. CMS assigned 0.55 work Relative Value Units (RVUs) to code 97605 and 0.60 work RVUs to code 97606. Relative Value Units are used to calculate the payment to providers. This means that healthcare practitioners such as MDs, PTs, PAs, DPMs and NPs, who prescribe V.A.C.® Therapy may be eligible for reimbursement for certain covered services related to NPWT. Healthcare practitioners who are eligible to seek reimbursement under the NPWT CPT codes are determined by state regulations that dictate what types of procedures each practitioner can perform. The dollar amount of the payment will vary, depending on the geographic location within the US and practice costs within that location. It is approximately $30.00 for 97605 and $40.00 for 97606.
 
Last edited:

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
AAOS didnt address the non-physician versus physician. The AMA clearly states that those codes are to be billed by non-physician providers.

I will stick the the AMA guideline on this one since the are the KING/QUEEN of CPT.


I have actually put an e-mail out to Margie Vaught to see what her response is to the conflicting information. I will update once I have received it.
 
Last edited:

Bella Cullen

Guest
Messages
499
Best answers
0
This is to answer if physicians can bill for wound vac. It says yes they can.
http://www.kci1.com/88.asp

I would be interested to know Margie's answer on that, but I used to bill 97605 out for podiatrists and plastic surgeons. I never had a problem. I think that rule changed.
Thanks
 

Bella Cullen

Guest
Messages
499
Best answers
0
Rules changed from medicare as of 1/1/2006, physicians can bill see links:

http://www.wpsic.com/medicare/part_a/publications/2006030100.pdf
starts on page 27

“Always” versus “Sometimes” Therapy
CMS defines an “always therapy” service as a service that must be performed by a qualified
therapist under a certified therapy plan of care, and a “sometimes therapy” service as a service
that may be performed by a non-therapist outside of a certified therapy plan of care.
Effective January 1, 2006, CMS is reclassifying CPT codes 97602, 97605, and 97606 as
“sometimes therapy” services that may be appropriately provided either as therapy or nontherapy

http://www.cms.hhs.gov/manuals/downloads/clm104c05.pdf
starts on pg 30.
ع+ 97605

ع If billed by a hospital subject to OPPS for an outpatient service, these HCPCS codes –
also indicated as “sometimes therapy” services - will be paid under the OPPS when the
service is not performed by a qualified therapist and it is inappropriate to bill the service
under a therapy plan of care. The requirements for other “sometimes therapy” codes,
described below, apply.
+ These HCPCS/CPT codes sometimes represent therapy services. However, these codes always represent therapy services and require the use of a therapy modifier when performed by therapists.
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
Margies response

Here is Margie Vaughts response....since the AMA rates higher than the AAOS, I'll be sticking to the AMA guidelines.

Today I just received more information where they are being told not only to report the wound vac after doing debridement but to also report for the dressing change 15852. I don't know where this is coming from and it is driving me crazy.. And today has been hateful as the majority of my day has been fighting 'we were told' situations.

I best I can give you is what you have from CMS and CPT and CCI and then you will have to decide.


CPT® Assistant June 2005 Volume 15 Issue 6
"Question: Is it appropriate for PHYSICIANs to report codes from the active wound care management series 97597-97606?

AMA Comment: Codes in the active wound care management series provide a mechanism for reporting interventions associated with active wound care as performed by licensed nonPHYSICIAN professionals. These codes are to be reported by nonPHYSICIAN professionals (eg, PHYSICIAN assistants, nurse practitioners, enterostomal therapy nurses, wound care nurses, physical therapists) licensed to perform these procedures. Only those individuals licensed by a particular state to perform the described services should use the codes to report services. As licensure varies from state to state, the applicable state laws and requirements determine who may perform specific types of services. For wound debridement performed by PHYSICIANs, see codes 11040-11044."

Here is what CMS appears to indicate:
Orthopedic Coder's Pink Sheet
Effective Date 09/01/2007
Publish Date September 2007
"Question:Can PHYSICIANs bill for negative pressure wound therapy codes 97605 and 97606?

Answer: Not according to CPT. The WOUND VAC codes are part of the active wound care management series, which “provide a mechanism for reporting interventions associated with active wound care as performed by licensed nonPHYSICIAN professionals” (CPT Assistant, June 2005).

“These codes are to be reported by nonPHYSICIAN professionals (e.g., PHYSICIAN assistants, nurse practitioners, enterostomal therapy nurses, wound care nurses, physical therapists) licensed to perform these procedures,” CPT says. Further, CPT tells you to check your state laws for licensure requirements and restrictions on who may perform specific types of services. PHYSICIANs should refer to the surgical debridement codes, 11040-11044 , CPT directs.

That should take care of some of the confusion generated by a parenthetical note in the CPT manual that tells you not to report codes 97597-97602 with 11040-11044, with no mention of whether the restriction also applied to the WOUND VAC codes, 97605 and 97606. Now, with the June 2005 CPT Assistant, we see that the AMA's intent is that PHYSICIANs not bill these codes.

Medicare may be different: You'll have to keep a close eye on your Medicare local coverage determination for its specific wound care billing policy. Medicare added work RVUs for the WOUND VAC codes in the 2006 PHYSICIAN fee schedule (Nov. 21, 2005 Federal Register). This year, for 97605, Medicare pays $33. For 97606 it pays $35.62 (both fees in the office setting, par, not adjusted for locality). Coverage, however, is tightly restricted:

“When the negative pressure wound therapy service does not encompass selective debridement, we consider the service to represent a dressing change and will not make separate payment,” CMS states in the 2006 Medicare fee schedule.
“When the negative pressure wound therapy service includes the need for selective debridement, we consider the services represented by CPT codes 97605 and 97606 to be bundled into CPT codes 97597 and 97598, meaning that we would not make separate payment for these services.” (2006 Medicare PHYSICIAN fee schedule)
Still, starting last year, Medicare changed the status for 97605 and 97606 from “bundled” to “active” in the PHYSICIAN fee schedule relative value file. Also, in April 2006, Medicare introduced CCI edits bundling the WOUND VAC codes as components of 11040-11044, but it later removed them, retroactive to April 1, 2006 .

Resources

Download the 2006 Medicare PHYSICIAN fee schedule payment policy for negative pressure wound therapy from the Nov. 21, 2005 Federal Register at: www.access.gpo.gov/su_docs/fedreg/a051121c.html

To see Medicare's RVUs, etc. for negative pressure wound therapy download the PHYSICIAN fee schedule relative value file at: http://tinyurl.com/2po4da"

Margie Scalley Vaught, CPC, CPC-H, CCS-P, MCS-P, ACS-EM, ACS-OR
Healthcare Consultant
 

Bella Cullen

Guest
Messages
499
Best answers
0
The AMA guidelines are from 2005 and the rule changed in 2006. Refer to my last response with the websites.
It states that those codes are referred to as "sometimes therapy" and in an outpatient setting physicians can bill for those codes.
And the original question that was asked, 97605 denied for dx only not any other reason.
I've billed these before in an outpatient setting and there was never a problem. Not sure why you are going with 2005 info when it changed in 2006, but that's up to you.
Thanks for sharing what Margie had to say.
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
I posted the bulletin about "always" versus "sometimes" to Margie and asked her how this plays into it ...we will see what she says. I'll post her response when received.
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
Margies response:

I don't think it affects it as it states 'performed by non-therapist' - which can be NPPs when not part of a therapy treatment plan

Then it goes on to talk about hospital issues:
"In order to pay hospitals accurately when delivering these “sometimes therapy” services
independent of a therapy plan of care, CMS is establishing payment rates for CPT codes 97597, 97598, 97602, 97605, and 97606 under the OPPS when performed as non-therapy services in the hospital outpatient setting.
Table 9 below lists the APC assignments and status indicators for these codes when delivered independent of a therapy plan of care in a hospital outpatient setting.

Margie Scalley Vaught, CPC, CPC-H, CCS-P, MCS-P, ACS-EM, ACS-OR
Healthcare Consultant
Coding Content Specialist for DecisionHealth
 

Bella Cullen

Guest
Messages
499
Best answers
0
That last comment doesn't really answer anything.
Here is where it says MD's can bill. I really don't want to keep going on and on about this. I just want people to know it is fine to bill this code for physicians. I used to bill this numerous times. It is ok to bill.
http://www.kci1.com/88.asp




6. Is there currently a CPT code that can be used to bill for application of V.A.C.® Dressings?

Effective January 1, 2005, Negative Pressure Wound Therapy (NPWT) was assigned two CPT codes for wound treatment by the American Medical Association (AMA):

CPT Code
Wound Size

97605
< or = 50 cm2 in surface area

97606
> 50 cm2 in surface area


CMS changed the payment status in the 2006 Medicare Physician Fee schedule to "A" (active status) for the NPWT CPT codes. CMS assigned 0.55 work Relative Value Units (RVUs) to code 97605 and 0.60 work RVUs to code 97606. Relative Value Units are used to calculate the payment to providers. This means that healthcare practitioners such as MDs, PTs, PAs, DPMs and NPs, who prescribe V.A.C.® Therapy may be eligible for reimbursement for certain covered services related to NPWT. Healthcare practitioners who are eligible to seek reimbursement under the NPWT CPT codes are determined by state regulations that dictate what types of procedures each practitioner can perform. The dollar amount of the payment will vary, depending on the geographic location within the US and practice costs within that location. It is approximately $30.00 for 97605 and $40.00 for 97606.
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
BUT keep in mind...KCI is the company/REP that supplies them...they will tell you anything to get you to use their product. Because you have done it in the past and have received payment isnt a good enough reason for me to do it. Each to their own, I just wont risk it it until I see something SOLID from the AMA/CPT. Right now everything still point to a "NO GO" for me.

I still believe that the AMA/CPT are the higher authority and take presidence over everyone else. The CMS Bulletin from 2006 addresses OPPS, not physicians.

Mary, CPC, COSC
 

Anna Weaver

True Blue
Messages
769
Location
Kokomo, IN
Best answers
0
wound vac

We haven't had a lot of luck with wound vac's either. Medicare refuses to pay. Most other private carriers also. When we started researching this a couple of years ago, we could not charge a wound vac and anything else on the same date of service. This was mainly for wound care. We were allowed either an E/M or a wound vac or a debridement. If the patient had a wound vac placed and a debridement on the same wound, the debridement was charged. If an E/M and a wound vac, a decision had to be made as to whether the E/M or a vac would be charged unless the documentation was over and above having the vac placed, as in a first time visit (but not usually because the vacs are usually ordered) then we would add a 25 modifier to the E/M, but as I said this was rare.. So, as I have read this, also, is mostly coder choice. We do not charge vacs and anything else on the same date of service. Documentation hasn't been sufficient for us to change that yet. This is one of those gray areas in our black and white world. Good luck!
 

Bella Cullen

Guest
Messages
499
Best answers
0
BUT keep in mind...KCI is the company/REP that supplies them...they will tell you anything to get you to use their product. Because you have done it in the past and have received payment isnt a good enough reason for me to do it. Each to their own, I just wont risk it it until I see something SOLID from the AMA/CPT. Right now everything still point to a "NO GO" for me.

I still believe that the AMA/CPT are the higher authority and take presidence over everyone else. The CMS Bulletin from 2006 addresses OPPS, not physicians.

Mary, CPC, COSC
If you look in the CPT book 2009 on pg. 441 it says right under Active Wound Care Management: Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing. Provideris required to have direct (one-on-one) patient contact.
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
If you look in the CPT book 2009 on pg. 441 it says right under Active Wound Care Management: Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing. Provideris required to have direct (one-on-one) patient contact.
thats correct, those are the instructions under the header. Under each individual CPT code it shows the CPT assist to obtain the updates and additional information that relate to those codes, which points to the CPT assistant Jun 05 and Insiders view 2005 for every one of them.

Like you I dont want to beat a dead horse. Everyone can take the information that has been provided and make the decision for themself if its worth the risk.

Personally, I have been coding ortho for 18 years, there is not an official source that has said its okay, therefore I will continue to follow the AMA on this. I'd love to see my docs get paid for it, but legally. I'm not willing to risk it and never been dinged in an audit for not doing billing it.

my last two cents on the subject :)
Mary, CPC, COSC
 

Bella Cullen

Guest
Messages
499
Best answers
0
thats correct, those are the instructions under the header. Under each individual CPT code it shows the CPT assist to obtain the updates and additional information that relate to those codes, which points to the CPT assistant Jun 05 and Insiders view 2005 for every one of them.

Like you I dont want to beat a dead horse. Everyone can take the information that has been provided and make the decision for themself if its worth the risk.

Personally, I have been coding ortho for 18 years, there is not an official source that has said its okay, therefore I will continue to follow the AMA on this. I'd love to see my docs get paid for it, but legally. I'm not willing to risk it and never been dinged in an audit for not doing billing it.

my last two cents on the subject :)
Mary, CPC, COSC
Well in my opinion there is not a risk and it is legal. I never used CPT assistant, I go by CPT book which comes from AMA and Ingenix coders desk reference, and I went by what Medicare says seeing that is what insurance denied the original question that was asked to begin with. I gave all the info I had, and I used to work for 48 surgeons, 6 different specialties, where they did audits all the time and there was never a problem, but that's that.
The ortho surgeon I work for now has not used wound vacs yet.
That is my final thought on that. ;)
 

WINDI89

New
Messages
4
Best answers
0
Cpc

I am an inpatient coder and i cannot find the correct icd-9 procedure code for the application of the wound vac. Any ideas...thanks
 
Top