Gloria Miller, CPC, CPMA, CPPM, former vice president of reimbursement services at Comprehensive Healthcare Solutions Inc. shares which CPT codes to use.
A version of this article was first published April 23, 2021, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.
Q: What CPT codes and modifiers would be used to report excisional debridement for removal of a 2x4-cm ulcer on a patient’s right buttocks with vacuum-assisted closure (VAC)?
A: The debridement would be reported using CPT code 11042 (debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less). This procedure involves the sharp removal of nonviable subcutaneous tissue until viable tissue is encountered.
Assuming the closure is performed using durable medical equipment, the VAC would be reported using CPT code 97605 (negative pressure wound therapy [e.g., vacuum-assisted drainage collection], utilizing durable medical equipment, including topical applications, wound assessment, and instructions for ongoing care, per session; total wound surface area less than or equal to 50 square centimeters) with modifier -59 (distinct procedural service) or -XU (unusual non-overlapping service).
Modifier -59 or -XU is appended to indicate that the VAC it is a distinct service from code 11042. The documentation should clearly state that the wound VAC was medically necessary because the wound was left open.
Editor’s note: This question was answered by Gloria Miller, CPC, CPMA, CPPM, former vice president of reimbursement services at Comprehensive Healthcare Solutions Inc. in Seattle, during the HCPro webinar, “Clean Up CPT/ICD-10-CM Coding and Billing for Wound Care.”
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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