WimsattP123
Networker
I am working in a General Surgeons office, and we had a rep come today for wound vac. I was wondering if anyone knows if this is billable or where I might be able to find some documentation?
Thank You
Thank You
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Wiki Wound Vac
- Thread starter WimsattP123
- Start date
Leanne
Networker
We use CPT 97605 for wound VAC:
Negative pressure wound therapy (eg, 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
Negative pressure wound therapy (eg, 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
mbort
True Blue
Question:Can physicians bill for negative pressure wound therapy codes 97605 and 97606?
Answer: Not according to CPT. The wound vac codes are part of the active wound care management series, which “provide a mechanism for reporting interventions associated with active wound care as performed by licensed nonphysician professionals” (CPT Assistant, June 2005).
“These codes are to be reported by nonphysician professionals (e.g., physician assistants, nurse practitioners, enterostomal therapy nurses, wound care nurses, physical therapists) licensed to perform these procedures,” CPT says. Further, CPT tells you to check your state laws for licensure requirements and restrictions on who may perform specific types of services. Physicians should refer to the surgical debridement codes, 11040-11044 , CPT directs.
That should take care of some of the confusion generated by a parenthetical note in the CPT manual that tells you not to report codes 97597-97602 with 11040-11044, with no mention of whether the restriction also applied to the wound vac codes, 97605 and 97606. Now, with the June 2005 CPT Assistant, we see that the AMA's intent is that physicians not bill these codes.
Medicare may be different: You'll have to keep a close eye on your Medicare local coverage determination for its specific wound care billing policy. Medicare added work RVUs for the wound vac codes in the 2006 physician fee schedule (Nov. 21, 2005Federal Register). This year, for 97605, Medicare pays $33. For 97606 it pays $35.62 (both fees in the office setting, par, not adjusted for locality). Coverage, however, is tightly restricted:
“When the negative pressure wound therapy service does not encompass selective debridement, we consider the service to represent a dressing change and will not make separate payment,” CMS states in the 2006 Medicare fee schedule.
“When the negative pressure wound therapy service includes the need for selective debridement, we consider the services represented by CPT codes 97605 and 97606 to be bundled into CPT codes 97597 and 97598, meaning that we would not make separate payment for these services.” (2006 Medicare physician fee schedule)
Still, starting last year, Medicare changed the status for 97605 and 97606 from “bundled” to “active” in the physician fee schedule relative value file. Also, in April 2006, Medicare introduced CCI edits bundling the wound vac codes as components of 11040-11044, but it later removed them, retroactive to April 1, 2006 .
Resources
Download the 2006 Medicare physician fee schedule payment policy for negative pressure wound therapy from the Nov. 21, 2005Federal Register at: www.access.gpo.gov/su_docs/fedreg/a051121c.html
To see Medicare's RVUs, etc. for negative pressure wound therapy download the physician fee schedule relative value file at: http://tinyurl.com/2po4da
Answer: Not according to CPT. The wound vac codes are part of the active wound care management series, which “provide a mechanism for reporting interventions associated with active wound care as performed by licensed nonphysician professionals” (CPT Assistant, June 2005).
“These codes are to be reported by nonphysician professionals (e.g., physician assistants, nurse practitioners, enterostomal therapy nurses, wound care nurses, physical therapists) licensed to perform these procedures,” CPT says. Further, CPT tells you to check your state laws for licensure requirements and restrictions on who may perform specific types of services. Physicians should refer to the surgical debridement codes, 11040-11044 , CPT directs.
That should take care of some of the confusion generated by a parenthetical note in the CPT manual that tells you not to report codes 97597-97602 with 11040-11044, with no mention of whether the restriction also applied to the wound vac codes, 97605 and 97606. Now, with the June 2005 CPT Assistant, we see that the AMA's intent is that physicians not bill these codes.
Medicare may be different: You'll have to keep a close eye on your Medicare local coverage determination for its specific wound care billing policy. Medicare added work RVUs for the wound vac codes in the 2006 physician fee schedule (Nov. 21, 2005Federal Register). This year, for 97605, Medicare pays $33. For 97606 it pays $35.62 (both fees in the office setting, par, not adjusted for locality). Coverage, however, is tightly restricted:
“When the negative pressure wound therapy service does not encompass selective debridement, we consider the service to represent a dressing change and will not make separate payment,” CMS states in the 2006 Medicare fee schedule.
“When the negative pressure wound therapy service includes the need for selective debridement, we consider the services represented by CPT codes 97605 and 97606 to be bundled into CPT codes 97597 and 97598, meaning that we would not make separate payment for these services.” (2006 Medicare physician fee schedule)
Still, starting last year, Medicare changed the status for 97605 and 97606 from “bundled” to “active” in the physician fee schedule relative value file. Also, in April 2006, Medicare introduced CCI edits bundling the wound vac codes as components of 11040-11044, but it later removed them, retroactive to April 1, 2006 .
Resources
Download the 2006 Medicare physician fee schedule payment policy for negative pressure wound therapy from the Nov. 21, 2005Federal Register at: www.access.gpo.gov/su_docs/fedreg/a051121c.html
To see Medicare's RVUs, etc. for negative pressure wound therapy download the physician fee schedule relative value file at: http://tinyurl.com/2po4da
Anna Weaver
Guest
wound vac
The way we did ours was:
1. If the patient had a debridement done on the same day and the vac was applied to that debridement site, no vac was charged, just the debridement.
2. If the patient had several debridements and vac applied to a wound that wasn't debrided, then the vac could be charged and a modifier applied.
3. If the patient had a change of vac only, no debridement, no office visit, we charged only the vac.
4. If the patient had an office visit separate and identifiable from the wound vac, then a 25 modifier with the wound vac (but gotta say this very rarely happened).
The way we did ours was:
1. If the patient had a debridement done on the same day and the vac was applied to that debridement site, no vac was charged, just the debridement.
2. If the patient had several debridements and vac applied to a wound that wasn't debrided, then the vac could be charged and a modifier applied.
3. If the patient had a change of vac only, no debridement, no office visit, we charged only the vac.
4. If the patient had an office visit separate and identifiable from the wound vac, then a 25 modifier with the wound vac (but gotta say this very rarely happened).
WimsattP123
Networker
Can these codes be used during a global period?
Thank You
Thank You
aguelfi
Guest
I have the same question
The rep that came in to my office said I can but can't provide me w/ any info stating we can. This is only when we do the dressing changes.
The rep that came in to my office said I can but can't provide me w/ any info stating we can. This is only when we do the dressing changes.
mbort
True Blue
My guess is that he can not provide you with documentation that states you "CAN", because all of the CPT assistant that I posted above state that physicians can not.
Its unfortunate that reps will tell you anything to get you to use their products
aguelfi
Guest
Thank you, I tried to tell him that and of course he said I was wrong. I do remember reading that an ARNP or PA can do it though and we do have a NP who is credentialed. I guess that would work. The only thing is he kept saying something about using a modifier to get paid. Is this a 24? I can't find anything on that but if the pt is in post-op and the NP is under the same Tax-ID then I would think a post-op modifier would apply.
aguelfi
Guest
I just found this in the LCD for wound care. What do you make of it?
CPT codes 97597, 97598, and *97602 require an appropriate therapy modifier (GP, GO, or GN) when the services are deemed therapy services, i.e., (a) Rendered by a therapist, or (b) Rendered by a physician or nonphysician practitioner, including incident to services, and integral to an outpatient rehabilitation therapy plan of care.
CPT codes 97597, 97598, and *97602 require an appropriate therapy modifier (GP, GO, or GN) when the services are deemed therapy services, i.e., (a) Rendered by a therapist, or (b) Rendered by a physician or nonphysician practitioner, including incident to services, and integral to an outpatient rehabilitation therapy plan of care.