Wound Vac Billing

Question:

I’m a general surgeon. Some of my team are reporting the negative pressure wound therapy codes 97605 and 97606 when applying wound vacs after closing at the completion of their surgical cases. As a result, I am told by my coders that billing for these wound vacs is not appropriate, since there is a Medicare NCCI edit that bundles this with more comprehensive procedures at the same anatomic area.
The physicians and coders disagree about how to handle these edits. Some of the physicians believe the wound vacs are billable because they are applied to the skin which constitutes a different body system. The coders think the wound vacs are dressings which are included in the global surgical fee and would not billable. After multiple discussions with the physicians and coders, we are unable to provide a definitive answer. Could I please ask you for your advice regarding this issue? What is the right answer?

Answer:

The AMA published clarification on wound vac billing in the October 2021 CPT Assistant. Negative pressure wound therapy (97605-97606) is considered billable for both open and closed wounds. However, that does not mean that payors will reimburse separately for the service, so use caution and track results.

*This response is based on the best information available as of 04/27/22

Catheterization Codes in Vascular Coding

Question:

Are there any vascular CPT codes that still allow separate reporting of selective and non-selective catheterization codes?

Answer:

Yes, the following procedures still allow separate reporting of catheterization codes

• Non- lower extremely, stenting, angioplasty, for example subclavian or renal arteries
• Peripheral embolization, for example hypogastric artery embolization during EVAR or uterine fibroid embolization
• Thrombolysis and thrombectomy
• Diagnostic angiograms and venograms (with the exception of cervical/cerebral and renal angiograms)
• IVUS
• TEVAR

Renal Angiogram Coding

Question:

Is catheterization separately reported with renal angiograms?

Answer:

No. The renal angiogram codes, see table below, include all catheterization. The codes are selected by order of catheterization and as unilateral or bilateral. Also, remember that a flush aortogram is included in the renal angiogram codes and not separately reported.

CPT Code	Description
36251	Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
36252	bilateral
36253	Supraselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral Do not report 36253 in conjunction with 36251 when performed for the same kidney.
36254	bilateral

Pelvic Angiograms

Question:

Is angiogram of the iliac arteries reported with the pelvic angiogram code, 75736?

Answer:

No, code 75736,Angiography, pelvis, selective or supraselectiveis only reported with selective or supraselective catheterization of the internal iliac arteries (hypogastric arteries) and interpretation of pelvic vasculature. For non-selective angiography of the common or external iliac arteries, use 75710 (unilateral) or 75716 (bilateral).

Billing for Multiple Embolectomies

Question:

How do we code multiple embolectomies of the aorta when using 34201? Do we code units by the number removed?

Answer:

34201,Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incisionis billed once per leg incision no matter how many emboli are removed from each incision. If this is performed bilaterally (two leg incisions), then bill 34201 with mod -50.

Coding Right and Left Carotid Stents at Different Operative Sessions

Question:

The physician staged a patient’s bilateral carotid stent with embolic protection procedures. The right carotid stent was done first and then the 6 weeks later the left side was done. What is the correct modifier on the second carotid stent?

Answer:

The second carotid stent, although staged clinically, is an unrelated procedure performed during the global period. Append a modifier 79 to code 37215 to indicate this unrelated procedure. Even though these are the same procedure reported with the same CPT code, they are performed at different anatomic locations and therefore are unrelated.