# wound vac change-I work for Trauma



## toccol (Feb 27, 2012)

I work for Trauma surgeons who frequently have patients who have abdominal surgeries where the wound is left open and wound vac dressing is placed.  The wound vac is changed every couple of days and therefore they enter the recent laparotomy wound for an abdominal washout.  We have been coding this as 49002 with the modifier 52 because the wound is not reopened.  We code a 97605 for the wound vac change. We are unsure if we are doing this correctly.  Does anyone out there have experience with this?  Also, once the wound needs closed, does anyone know if this portion is billable and how?


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## cwpierce (Feb 29, 2012)

I too code for Trauma surgeons and I use 49002 -58. I use a 58 rather than a 52 because it is usually a planned procedure to go back in and check on the abdomen and/ or wound closure status. I also use 998.83 and V58.41 as my Dxs to drive my CPT code.

When in comes to wound closing you will need to ask your surgeons how they would like it coded. Normally I would go with 13160-58 however I have certain surgeons who insist I still use 49002-58. I have a letter on file stating that this is how the surgeons would like final closure to be coded so I am covered.

Hope this helps.....
Casey


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## toccol (Feb 29, 2012)

*wound vac change*

Thank you, Casey.  We have been having issues with payment.  Maybe this will fix the problem.


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## Lujanwj (Feb 29, 2012)

Just a thought but I'm not so sure Dr is doing the work involved with code 49002(30.42 RVU's).  I think I would use an unlisted 49999 for removing, washing out and applying new vac.  If he just changing the vac I would use 15852(1.38 RVU's).  You might try a -22 on that for the washout if you don't want to do the unlisted.  I just don't see Dr actually reopening as the patient was never closed.  This isn't an easy or straight forward deal.  If anyone out there has a definitive answer please post.


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## JJackson506 (Mar 1, 2012)

toccol said:


> I work for Trauma surgeons who frequently have patients who have abdominal surgeries where the wound is left open and wound vac dressing is placed.  The wound vac is changed every couple of days and therefore they enter the recent laparotomy wound for an abdominal washout.  We have been coding this as 49002 with the modifier 52 because the wound is not reopened.  We code a 97605 for the wound vac change. We are unsure if we are doing this correctly.  Does anyone out there have experience with this?  Also, once the wound needs closed, does anyone know if this portion is billable and how?



The work being done does not represent the work of 49002 which includes "The previous abdominal incision is opened by removing skin staples and individually dividing the fascial sutures from the previous laparotomy closure.  Any retention sutures are also removed.  Hemostasis is achieved using electrocautery and small ligatures, as necessary. The fascial edges and adherent peritoneum are carefully separated taking care to avoid injury to any underlying adherent bowel.  Cultures are obtained of the intraperitoneal fluid and any excess fluid is evacuated.   A complete abdominal exploration is performed beginning with the site of the previous small bowel anastomosis.  Area of fibrinous exudate and newly formed adhesions are carefully separated and the small bowel examined, revealing the site of the anastomosis to be completely intact with no evidence of a leak or vascular compromise.  The small bowel mesenteric vessels show excellent blood flow with no evidence of arterial or venous occlusion, and no evidence of an internal hernia.  The remainder of the abdominal cavity is then evaluated to ensure the absence of other acute pathology.  Adhesions are cleared by sharp dissection in order to expose all of the abdominal viscera.  The position of the NG tube is confirmed.  The stomach is inspected and palpated for pathology.  The duodenum is visualized and palpated.  The small bowel is inspected and palpated from the ligament of Treitz to the ileocecal valve.  No obvious areas of ischemic bowel are identified.  The cecum and appendix, ascending, transverse, and descending colon are inspected.  The abdominal cavity is irrigated copiously with antibiotic solution.  Hemostasis is obtained.  The abdomen is inspected for injury and the presence of any instruments of lap-pads (i.e., count is made).  The retractor components are removed and accounted for.  The abdominal organs are returned to normal anatomical position.  The omentum is draped over the abdominal contents.  The fascia is closed with running suture, and retention sutures are placed as needed.  A second instrument, needle, sponge, and lap-pad count is conducted.  The subcutaneous tissues are irrigated and approximated and the skin is closed."

The only code that should be used is 97605 which work includes " Thoroughly clean the wound and assess the wound to assure no sinus tracts and/or fistulas are present. Clean skin around the wound and prepare for the application of transparent film. Insert tubing and connect to the negative pressure therapy pump. Set pump parameters and activate. Inspect for leaks and clogs, and the need for canister replacement."

I would suggest that 97605 is the only code that should be billed for the work that is described.


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## Lujanwj (Mar 1, 2012)

Can we get more clarification on 97605?  It seems like that code is for non-healing or complex wounds and doesn't cover entering the cavity.  Based on the description "And instructions for ongoing care" this is meant for something less invasive and can be done  as an outpatient procedure.  Wouldn't there be more risk involve dealing with abdominal washout?  A lot of the time I see a wound vac used is so Dr can go back in to make sure an anastomosis is healing or something along those lines.  It seems like there's a good amount of risk involved in that.  Appreciate the help.


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## FTessaBartels (Mar 2, 2012)

*Hard to tell without the actual op notes*

It's hard to tell without the actual op notes.  However, if they are actually going into the abdominal cavity for washout that is more than just changing a VAC dressing.  We would code 49002 (M58, M52).  We use M58 to indicate that it is a staged procedure, and M52 to show reduced service (since they do not have to re-OPEN the abdomen in these cases). 

We never code the VAC dressing when there is a definitive surgical procedure; just as you would not code the suturing of a surgical wound ... i.e. it is the method of closure (albeit temporary). 

If ALL they do is change the dressing, maybe taking a quick look at status of wound healing, then we code 97605.  

Of course, this *all* depends on the documentation.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## knperry (Dec 2, 2012)

If the washout was not a reopen what code would you use then?  Say during a exploratory laparotomy and all that was done was a abominal washout?


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