October 13, 2023 

Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group.

1. Are injections like Lupron and Prolia and the administration given by an advanced practice provider subject to the 85% reimbursement or are these reimbursed at 100% even if given by a nurse practitioner?
2. Are 11006 and 97606 appropriate here for wound vac?
   
   OPERATION: Debridement of Fournier's gangrene.
   
   DRAINS: Wound VAC, 16-French Foley catheter.
   
   OPERATIVE TECHNIQUE: The patient was brought into the operating room, placed in supine position on the operating room table. After administration of IV antibiotics and anesthesia, the patient was repositioned in dorsal lithotomy position, prepped and draped in the usual sterile fashion. The wound measured approximately 30 cm x 14 cm and went from the left inguinal region through the left perineum and to the posterior left buttocks. Using a curettage, we proceeded with additional debridement of all the raw surfaces. Spot electrocautery was used as needed for hemostasis and the wound was irrigated copiously with antibiotic irrigation. The sharp debridement was done to the level of the dartos fascia and Colles fascia. Once we had finished the sharp debridement, we went ahead and decided to place a wound VAC. A black sponge was placed into the wound and then carefully placed using the sticky plastic and put it to suction. Given the location, it was a bit challenging but we were able to place the wound VAC to suction. Given that the wound extended near the posterior buttocks, it was near the anus which would likely be an issue for maintaining suction if the patient had a bowel movement. The patient tolerated the procedure well.

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