Medicare Compliance & Reimbursement

Question: When the surgeon performs a wound VAC or cleans a wound by scraping with a sharp curette (not excising tissue), is it appropriate to use a debridement code or should we report an active wound care management code from the range 97597"97606?

Answer: Physicians typically use the debridement codes (11000"11001, Debridement of extensive eczematous or infected skin; ... or 11004"11005, Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; ...) for debridement by any method.

Without question these codes most closely describe wound debridement by sharp curettement. You should only report wound care management codes such as 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; ...) for a therapeutic service that involves more than simple wound debridement.

These codes require "direct (one-on-one) patient contact" to debride the site and "promote healing," according to CPT instruction. As the definition indicates, the encounter involves topical applications and patient care instruction in addition to removing devitalized tissue.

AMA weighs in: The June 2005 CPT Assistant states, "Codes in the active wound care management series provide a mechanism for reporting interventions associated with active wound care as performed by licensed non-physician professionals. For wound debridement performed by physicians, see codes 11040"11044." In other words, active wound care management codes describe wound therapy, not just surgical debridement.

Even if your surgeon places a wound Vacuum Assisted Closure (VAC) during surgery, be aware that payers often bundle the service. Payers may consider placing the wound VAC to be little more than fancy "bandages." Check with your payers to be sure you follow their instruction so you can maximize your reimbursement for this service.