General Surgery Coding Alert

Question: When I billed a wound VAC code to Medicare along with a debridement (11005), Medicare denied the wound VAC code. The diagnosis I used was covered under the LCD for Medicare. Can I appeal this?

Texas Subscriber

Answer: Most likely, your surgeon performed this procedure in the hospital. In that case, you won't be able to appeal this denial successfully. Medicare has bundled negative-pressure therapy, or vacuum-assisted  drainage collection (often shortened to VAC or VAD) placement (97605-97606, Negative pressure wound therapy [e.g., vacuum assisted drainage collection], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session ...) in the operating room since 2006. You should have reported just the debridement code: 11005 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure).

Plus: The Correct Coding Initiative (CCI) applies hundreds of edits to 97605-97606, bundling the services  into procedures such as debridements, burn treatments, lesion destruction, and amputation, among others.

Therefore, before you report 97605-97606 with any other services, be sure to check the CCI to be sure it doesn't bundle the codes.