Wiki Wound Vac

[hsmith67]

Received a denial for 97605 from Humana. The denial states "submitted medical records does not include documentation that supports negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session..." Apparently Humana is sticking to the letter of the total definition of the code as the op note does not include documentation of "wound assessment, and instruction(s) for ongoing care." Anyone else seeing this denial? Thoughts?

Thanks for any help,
Hunter Smith, CPC

 

[OpenClaims]

Are you billing for the hospital or the provider(profee). If you are billing for the physician is the physician a DME provider. Is he allowed to aquire DME products and then bill for them in his office?

 

[hsmith67]

Are you billing for the hospital or the provider(profee). If you are billing for the physician is the physician a DME provider. Is he allowed to aquire DME products and then bill for them in his office?

I'm billing for the professional fee for the provider to place the wound vac in the OR, supplied by the hospital. I am not billing for the wound vac itself, the hospital is doing that.

 

[OpenClaims]

Ok awesome, so 97605 is for DME products, which you, as the profee coder, would not be billing for because the hospital has purchased this and you are just using it. If the patient is closed up and the wound vac is used to help with the healing of the closure of the patient, then you would not code a wound vac code at all since this would be part of the closure. If the patient was left open and a wound vac was applied to the open area in the OR then you could use a wound vac code depending on the documentation. The documentation would have to substantiate the medically necessary reason for the wound vac.