Learn how to code Vacuum- assisted drainage collection

Vacuum- assisted drainage collection
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Negative-pressure therapy, or vacuum-assisted drainage collection (sometimes abbreviated either VAC or VAD), allows physicians to treat patients with diabetic pressure ulcer or other sores without debriding tissue.

CPT has two codes to describe this treatment:

·         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

·         97606 -- ... total wound(s) surface area greater than 50 square centimeters.

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Document Surface-Area Measurements

To apply 97605 and 97606 appropriately, you must have documentation that specifies the surface area of the wound the physician treated. If the provider performs VAD on a wound that's less than or equal to 50 sq cm, you should report 97605. And when the wound is greater than 50 sq cm, you should report 97606.

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.

VAC codes are open to physicians: Although wound care codes 97597-97602 are reserved for nonphysician practitioners, physicians can report 97605-97606.

Watch Out for Dx, Other Limitations

Prior to 2006, the Medicare fee schedule assigned zero relative value units to 97605 and 97606, and labeled the codes as "status C," or carrier-priced.

In practice, this meant that although many payers would allow that VAC procedures could be medically necessary for certain diagnoses, they would not separately reimburse for the procedures under any circumstances.

Good news: Medicare now provides RVUs for 97605 and 97606, thereby mandating payment for the services when medically necessary.

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 coverage of 97605-97606 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 vicinity of the wound.

A must: Contact your local carrier for a complete list of covered ICD-9 codes. But remember: You must report a diagnosis supported by clinical evidence. You should not select a diagnosis merely to obtain coverage.

Most payers 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).

Bundles Could Still Stump You

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

Always check: Before reporting 97605-97606 with any other services, be sure to check CCI to be sure the codes aren't bundled.

You can use a modifier (such as modifier 59, Distinct procedural service) to override almost all of the edits, however, if you provide wound care in a separate anatomical location (for instance, if debridement occurs at one location and VAC occurs at a separate, distinct location).

Bottom line: In most cases that your practice might provide negative-pressure wound therapy, you'll probably find that the service is bundled into other procedures the physician provides.

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