We are getting denials for wound vac with debridement codes as "inclusive". Everything I find says 97605 has been unbundled. Hoping someone can point me in the right direction for more information on this. Thanks.
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Wiki 11042 and 97605
- Thread starter andreasuemoore@hotmail.com
- Start date
TThivierge
True Blue
CPT 11042 and 97605 not paying
Hi Andrea,
Ah nope that will not work CPT codes 11042 and 97605. Read page 690 in the CPT manual 2018 on left bottom page .... the CPT code 97065 not mentioned but insurance company must think it is not payable. If a different area will cover, cannot be billed for same wound. Send the notes to the insurance company .But it says wound advice in CPT 97605 probably reason not covering it.
I hope this info helps you
Lady T
Hi Andrea,
Ah nope that will not work CPT codes 11042 and 97605. Read page 690 in the CPT manual 2018 on left bottom page .... the CPT code 97065 not mentioned but insurance company must think it is not payable. If a different area will cover, cannot be billed for same wound. Send the notes to the insurance company .But it says wound advice in CPT 97605 probably reason not covering it.
I hope this info helps you
Lady T
Thank you Lady T!
glcornett
New
Even though this response is a couple of years late
, check your status indicators. 97605 has a status indicator of Q1 meaning reimbursement will be packaged with codes with status indicators S, T, or V (11042 has a status indicator of T).DRSZ1
Contributor
what about billing 97606 and 11042? does the same rule apply? If a different area will cover, cannot be billed for same wound.???