Dressing change with application of Vac

Does anyone have any advice on how to code the following procedure?

Dressing change with application of VAC, dressing, and examination of left elbow under flouroscopy.

We billed out 24635 two days prior to trying to bill out the above procedure. Any ideas?

Aliza

wound vac

This is a dressing and not separately billed. Remember the global is 90 days and unless you return the patient to OR in global period (-78), related procedure, you cannot bill separate procedures done in the office or outpatient clinic by surgeon. Why the Fluoro?

Dressing change with application of Vac

This does not fall under the global period. This was a return to the OR. Why the flouro? From what I can tell from the procedure report, the doctor was checking fracture position, stability, and rotation of the radial head. The code 24635 excludes "complex wound closure (eg, application of wound vacuum device to open wound, (eg, 97605-97606)) or closure requiring local or distant flap coverage and/or skin graft, when appropriate (eg, 13100-13160, 14000-14350, 15000-15400, 15570-15776)"

The doctor suggested we bill 97597, any suggestions?

Aliza

wound vac

The wound vacuum dressings cannot be reported in addition to the wound debridement codes. (Medicare) - The only time the wound vac codes can be reported is if it is the only procedure performed at the wound site. If debridement is a staged procedure, modifier 58 is used in global. look at the CCI edits as well when performing debridement. Otherwise I cannot suggest codes without reading the op note.
Download the 2006 Medicare physician fee schedule payment policy for negative pressure wound therapy from the Nov. 21, 2005 Federal Register at: www.access.gpo.gov/su_docs/fedreg/a051121c.html