# Billing for V.A.C.



## jdibble (Mar 16, 2011)

Our plastic surgeon performed a Split-thickness skin graft on the patient's leg and during the surgery she placed a wound VAC.  I was on the fence about billing the wound VAC with procedure 97605 and after researching the boards here, I decided that this would be included in the procedure.  The description on this code also seems like it would be used more for an office therapy rather than a surgery.

The plastic surgeon is questioning why this procedure was not billed and is stating that she believes that code 15852 should be billed for the placement of the wound VAC.  When I read this procedure it states for Dressing change under anesthesia so I would not have chosen this.  She states that she was told that since there is not specific code for a VAC this code could be used - I'm not sure if this was told to her by a sales rep or who.

Can some one tell me how they handle wound VAC during surgery - would it be appropriate to code the dressing change for a placement? Or is this considered part of the primary procedure?

I appreciate any help and documentation to support it if possible. 

Thanks,


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## surgonc87 (Mar 16, 2011)

If patient comes in just for the vac change, I think its safe to say we can use 15852, if it supports the description of procedure. If debridement was done on the same location, logically you have to take off/replace to vac in order to deride, hence the CCI edit with ex;11043.

I say, if it does not hit any bundling issues, and it makes sense not to double dip, by all means we can, with supporting DX

I've used 15852 before in the OR under anes for vac changes since our facility advise on not using 97605.

MS


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## jdibble (Mar 17, 2011)

*Is this for VAC placement?*

Thanks MS for your reply.  

I understand if she takes the patient back under anesthesia to change the dressing I could use 15852 - or use the drebridement code only if she debrides. In this circumstance however it was not a dressing change.  This was the initial placement of the VAC in the OR suring the skin graft procedure.  Code 15852 states for dressing change - not for placement of the VAC.  The doctor wants to use the code for changing the dressing when the procedure was placement.  Is this correct?  Or is this something that would be considered part of the primary procedure?  

Thanks,


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## surgonc87 (Mar 17, 2011)

I've worked in Milwaukee for plastic surgeons, we did report 97605,97606 in the OR and office procedure room...No prob with that

Now where I work, we don't report it because that is bundled into additional facility charges...and it is looked upon as therapeutic and not surgical

So it is up to your facility to go for the ride. I say either way goes to do or not but yes I agree that 15852 should not be reported for initial vac placement.

MS


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## bran1120 (Mar 17, 2011)

Initial placement of the VAC is considered to be part of the closure and is not separately billable.  It is not considered to be any different than the surgeon suturing the wound closed.  

For VAC changes I would say that coverage of the service depends on the patient's insurance.  Medicare considers the VAC changes part of the normal post-op follow-up and is not separately payable unless there is a return to the OR.


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## jdibble (Mar 21, 2011)

*Thank you!*

Thanks everyone for your responses - they have all been very helpful!


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