General Surgery Coding Alert

Question: I-ve heard that we can now bill Medicare for VAC therapy (as of 2006). Is this true? When is this procedure appropriate?

Florida Subscriber

Answer: Yes, you can report vacuum-assisted collection (VAC) codes 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) and 97606 (... total wound[s] surface area greater than 50 square centimeters) for Medicare payers.
 
Prior to 2006, the Medicare fee schedule assigned zero relative value units to 97605 and 97606, and labeled the codes as -status B,- 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.
 
For 2006, Medicare provided RVUs for 97605 and 97606, thereby mandating payment for the services when medically necessary -- although payment to the physician will still equal less than $20 in most areas.
 
Local Part B payers vary in the exact diagnoses they will allow to support a claim of 97605 or 97606, 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.
 
Tip: Contact your local carrier for a complete list of covered ICD-9 codes. 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).

 -- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.