02/21/2019

Correct Coding for Versajet Debridement of a 25 sq cm Wound & Application of an Integra Graft

How would you code Versajet debridement of a 25 sq cm wound and application of an Integra graft to cover this wound? I billed 95597, 97598, 15275,15276..the 97597 & 97598 got rejected. Due to “procedure code rebundled”

The Versajet debridement of the site was denied by Healthfirst due to a CCI edit; where the service would be considered inclusive to the preparation of a site; where a skin substitute would be applied, which would be included in the payment of CPT code 15275 & 15276. The application of the skin graft and the wound debridement are only payable on the same encounter if:

• Modifier -59 or one of the -X[EPSU] modifiers are appended to the Versajet procedure
• The documentation from the DOS clearly indicates that the wound debridement was performed on a different site of the patient’s foot or ankle that was not part of the area that received a bioengineered skin substitute

If the documentation cannot support this, Healthfirst will uphold the denial for bundling by including the Versajet payment in with the skin graft application.