Dermatology Coding Alert

Don't code anesthesia separately with wound therapy, Medicare says

If you're using cutting-edge wound care techniques in the office, you may be too advanced to receive any Medicare payment. That's what the latest set of NCCI rules, effective April 1, dictates.

Bad news: Active wound management codes 97602 (Removal of devitalized tissue from wound[s], non-selective debridement, without anesthesia, including topical application[s], wound assessment and instruction[s] for ongoing care, per session) and 97605-97606 (Negative-pressure wound therapy ...) become components of 556 different codes as of April 1, including many codes from the integumentary system surgery section. They also become components of a large number of lesion destruction codes.
 
Meanwhile, codes 97602-97606 also become mutually exclusive with these debridement codes:

• 11000--Debridement of extensive eczematous or infected skin; up to 10 percent of body surface
• 11010-11012--Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s) ...
• CPT 11720 -CPT 11721 --Debridement of nail(s) by any method(s) ...

NCCI Edits version 12.1 also bundles 97602-97606 into these burn treatment codes:

• 16000--Initial treatment, first-degree burn, when no more than local treatment is required
• 16020-16030--Dressings and/or debridement of partial-thickness burns, initial or subsequent ...
• 16035--Escharotomy; initial incision.

These bundles have a modifier indicator of "1," which means you may use modifiers to break the bundles and report the two procedures separately if circumstances allow, says Rena Hall, CPC, coder for a surgery group in Kansas City, Mo.

Expect Some Denials for Negative Pressure

Carriers are already denying claims for negative- pressure wound therapy codes 97605-97606 along with a debridement, says Suzan Hvizdash, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh.

But you won't be able to use a modifier to override most of the edits that make 303 other codes into components of 97602-97606, including virtually every code from the anesthesia section of the CPT book.
 
Dermatologists don't usually perform negative- pressure wound therapy with anesthesia in the office,  Hvizdash says. In the operating room, surgeons will use anesthesia when the wound is deep or painful, and CMS should pay for it separately, she says.

But you can't use a modifier to override edits that make 97602-97606 mutually exclusive with wound care management codes 97597-97598 (Removal of devitalized tissue from wound[s], selective debridement, without anesthesia, with or without topical application[s], wound assessment, and instruction[s] for ongoing care, may include use of a whirlpool ...), and 97602-97606 mutually exclusive with each other.

Commentary: Negative-pressure wound therapy is very effective for many patients, Hvizdash says. "It's very distressing that CMS is not looking at it as a separately identifiable procedure. It is time-consuming, and there is medical decision-making involved," she adds. This therapy decreases complications and hospital lengths of stay, but it receives minimal reimbursement when you can get paid for it at all, she says.

Debridement Codes Under Fire

Separately, a number of codes become components of excision and debridement codes 11004-11006 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft-tissue infection ...):

• 10060-10061--Incision and drainage of abscess ...
• 11000--Debridement of extensive eczematous or infected skin; up to 10 percent of body surface
• 11010-11012--Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s) ...
• 11040-11044--Debridement; skin ...

Good news: NCCI 12.1 does delete one set of formerly troublesome edits. Starting in April, lesion excision codes 11600-11646 will no longer be components of tissue transfer or rearrangement codes 14000-14300.

Find out more: View the complete set of NCCI edits at www.cms.hhs.gov/NationalCorrectCodInitEd/.