Wound Vac Billing

Question:

Can a wound vac be billed if a wound is partially sutured and partially left open?

Answer:

Billing for a wound vac depends on whether the wound is considered open or closed. According to coding guidelines, negative pressure wound therapy (NPWT) codes (97605-97608) are only reportable when placed at an open wound site. If a wound is partially sutured but still has an open portion, the wound vac may be billable, provided the documentation supports its use for the open wound. However, if the wound vac is applied over a closed wound, it is generally considered a dressing and not separately billable.

To ensure proper billing, documentation should clearly indicate the wound's size, depth, and the necessity of NPWT. Some payors may have specific rules, so checking with the relevant insurance provider or Medicare guidelines is recommended.

*This response is based on the best information available as of 7/17/25.

Thrombolytic Infusion

Question:

If a thrombolytic infusion catheter is placed and later in the day it is removed for an interventional procedure and then replaced after the procedure, what is the correct code to report?

Answer:

CPT code 37211 is for the entire day of initial thrombolytic therapy. No additional code would be billed for catheter replacement on the same day.

*This response is based on the best information available as of 7/17/25.

10180 vs. 23930

Question:

Our surgeon did ORIF of a humeral shaft fracture. A few weeks later, the patient developed a postoperative infection. Diagnosis is 'Infected hematoma, left humerus'.

Excerpt from note:

“I removed all the sutures from the skin and the subcutaneous and immediately encountered a large amount of purulent material. This was completely evacuated. Multiple cultures were sent for culture. I debrided starting with the skin down to the level of bone and washed out with a combination of saline…...”

I considered submitting CPT 23930 Incision and drainage, upper arm or elbow; deep abscess or hematoma. CPT 10180 Incision and drainage, complex, postoperative wound infection could also work. Which one would be a better choice here, considering it was a musculoskeletal procedure?

Answer:

Thank you for asking KZA!

Some seemingly more straightforward cases that cross coding desks often provoke deep thought. KZA can appreciate reviewing and considering codes 10180 vs. 23930 for this scenario.

Based on the information in the excerpt from the note in the inquiry, KZA would assign CPT 23930.

The rationale: The tissues involved were deeper than the skin and deeper subcutaneous tissues for this incision and drainage. Additionally, debridement is considered included in CPT 23930.

*This response is based on the best information available as of 7/17/25.

LECA & Lami?

Question:

Our practice is slightly confused. In the setting of a LECA corpectomy, is a laminectomy separately reportable? Can KZA provide some clarity for our practice?

Answer:

Thank you for asking KZA!

Identifying the intent of the laminectomy is essential.

A lateral extracavitary corpectomy (LECA) includes laminectomy for access. If the laminectomy is performed just for the approach and access to the anterior spine, it should not be reported in addition to the LECA corpectomy – this is included.

In instances where a separate tumor is present, such as an extradural tumor, and a laminectomy is required to resect the posterior portion of the tumor, this may be reported separately and in addition to the lateral extracavitary corpectomy (LECA).

*This response is based on the best information available as of 7/17/25.

Claim Denial with Modifiers 24/58

Question:

I have been getting denied for office visits (99212-99215) billed during a global period. I bill the E/M code with a modifier 24, and/or 58 and the claims still get denied for “separately billed services/tests as they are considered components of the procedure. Separate payment is not allowed.” According to the conferences I have attended for KZA, we’ve been told that we can bill and E/M code with modifier 24, but the insurances do not cover it. Do you have any other suggestions on how to get these claims paid?

Answer:

Thank you for your question. Billing an E/M service during a global period can be tricky, especially when insurers bundle them into the procedure. Here are some strategies to improve claim approvals:

1. Ensure Documentation Supports the Modifier

• Modifier 24: Must show that the E/M service is unrelated to the procedure. If the visit is for post-op care, insurers will likely deny it.

• Modifier 58: Used for staged or related procedures, not routine post-op visits or visits unrelated to the procedure.

2. Check Payor-Specific Guidelines

• Medicare and private payors may interpret what qualifies as an unrelated E/M service differently.

• Some payors require additional documentation proving medical necessity.

3. Use Diagnosis Codes That Support Unrelated Services

• If the diagnosis code is too closely related to the procedure, payors may still bundle the visit.

• Consider adding supporting notes explaining why the visit was medically necessary.

4. Appeal Denied Claims

• If you believe the denial was incorrect, submit an appeal with detailed documentation.

• Include payor guidelines that support separate reimbursement.

*This response is based on the best information available as of 7/17/25.

Wart Destruction with Liquid Nitrogen

Question:

I saw an established patient who I see for evaluation of a wart on the arm. The wart is moderate in severity. I evaluated the wart, performed a skin exam and removed the wart with liquid nitrogen and told the patient to come back PRN. My coder tells me I can only report the wart destruction and not a visit code. Is that correct?

Answer:

It appears the focus of the visit is the removal of the wart (17110). Unless you have a significant separately identifiable E/M service, the E/M service would be inherent to the procedure. Keep in mind the procedure includes pre-service work which is the E/M service. Only the procedure should be reported in the situation you described.

*This response is based on the best information available as of 7/17/25.