97597 CPT Code: Know Your Codes

October 5, 2020Wound Care

97597 CPT Code Description

Debridement (e.g., high-pressure waterjet with /without suction, sharp selective debridement with scissors, scalpel, and forceps), open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudates, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less. Add on CPT code 97598: each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) (use 97598 in conjunction with 97597 CPT code)

Physical Medicine and Rehabilitation (PM&R) Codes (i.e. 97597, 97598, 97602)

A physician, NPP or therapist acting within their scope of practice and licensure may provide debridement services and use the PM&R codes including CPT 97597, 97598 and 97602.
These codes must only be billed for services that include medically necessary skilled debridement services.
Hospital staff acting within their scope of practice and/or licensure may provide wound care, including debridement services, incident-to the services of a physician/NPP.
Staff providing therapy services incident-to the physician treatment plan must meet the qualification guidelines established for auxiliary personnel.
CPT 97597, 97598, 97602 are considered “sometimes therapy”. These treatment codes may be provided without a therapy plan of care by physician/NPPs or as incident-to services. When these “sometimes therapy” services are provided under a physician’s/NPPs treatment plan they should be billed without a therapy modifier.
When wound care services are delivered by therapists, there must be a physician certified therapy plan of care based on a thorough evaluation signed by the treating physician or NPP. The services must be billed using the appropriate therapy modifier and deliver within the CMS therapy guidelines.

A dressing change may not be billed as either debridement or other wound care service under any circumstance (e.g., CPT 97597, 97598, 97602). Medicare does not separately reimburse for dressing changes or patient/caregiver training in the care of the wound. These services are reimbursed as part of a billable E/M or procedure code that, commonly but not necessarily, occurs on the same date of service as the dressing change. If not included in another service, the costs associated with dressing changes may be reported as not separately payable.

How To Select The Correct Debridement Codes

Debridements are classified as Excisional (CPT codes 11042-11047); Selective (CPT codes 97597-97598); and Non-selective (CPT code 97602). Select the correct debridement codes based upon the following three criteria:

The type of tissue debrided, not necessarily the depth of the wound. If you only debride subcutaneous tissue on a wound that has bone exposed, you would still only bill CPT 11042 as subcutaneous tissue is what you debrided from the wound.
The aggregate size of the wounds based upon 20 cm² increments, not the number of individual wounds.
If there are multiple wounds from which you have debrided a different tissue type, lump all similar wounds (based on the type of tissue you have debrided) together. For example, if debriding bone from wound #1 (< 20 cm²), bill CPT 11044. If debriding muscle from wound #2 (<20 cm²), then also bill CPT 11043 -59 for the second wound since you are debriding different tissue. Append the lesser debridement code with the 59 modifier.

On the other hand, if the above scenario includes debridement of bone from wound #1 (<20 cm²) and debridement of muscle from multiple wounds with an aggregate of 30 cm², billing would be CPT 11044 for wound #1 (<20 cm²) and CPT 11043-59 (for the first 20 cm²) along with CPT 11046 for the additional >20 cm2 debrided for the other combined similar wounds. You can mix and match all combinations of CPT code 11042-11047 based upon the tissue you have debrided and the aggregate size of the wounds. Use 59 modifiers to separate out each principal debridement code (versus add-on codes).

The global period for all debridement codes is now ‘zero’ days. Keep in mind that the wound debridement codes may still be impacted from the global period of other procedures (such as amputation or other surgery) you may have performed. Coders cannot report an excisional debridement if the debridement does not include at least one of the following:

Bleeding tissue
Removal of viable tissue
Increasing wound size by width, length, or depth

In cases that don’t meet any of the above criteria, coders may assign an E/M visit level, removal of devitalized tissue, or a non-selective debridement. The removal of devitalized tissue is called selective debridement or active wound management. Coders should only report these codes once per visit, regardless of how many wounds are debrided. These codes are only used when a provider removes nonviable tissue, and coders should not see the documentation of bleeding (which indicates living tissue).

Example of 97597 CPT Code

One ulcer 4cm x 4cm of dermis removed
- 97597 CPT code one unit
Two ulcers: first 2cm x 2cm, second 4cm x 4cm of dermis removed
- 97597 CPT code one unit
Three ulcers: 2cm x 2cm, 3cm x 2cm, 2cm x 2cm of dermis removed
- 97597 CPT code one unit

Note that always code based on depth of tissue actually debrided, not the depth of the wound. Sq. cm. used is amount of tissue debrided, not the size of the ulcer

Ulcer is 6cm x 5cm to depth of dermis and you debride 4cm x 4cm of tissue to dermis:
- CPT 97597

A 58-year-old woman presents for follow-up care with a pressure ulcer on the left plantar heel. The wound measures 3.5 cm x 3.0 cm x 1.0 cm. She previously underwent extensive debridement. It is determined that the wound edges and the wound bed are viable with granulations but covered with an adherent proteinaceous slough, fibrin, and debris. After review, it is determined that the patient’s wound would benefit from selective active wound care management.

Documentation

Selective Debridement (CPTs 97597 and 97598) – Documentation to support selective debridement should include the following:

A clear description of instruments used for debridement (i.e. high-pressure waterjet, scissors, scalpel, forceps).
Thorough objective assessment of the wound including drainage, color, texture, temperature, vascularity, condition of surrounding tissue, and size of the area to be targeted for debridement.

We hope that this article has provided basic guidelines about the 97597 CPT code. If you are looking for overall billing and coding services you can refer to E2E Medical Billing Services. Our accurate and affordable billing services will eliminate billing and coding errors and will increase your practice collection. To know more about our medical billing and coding services, call us at 888-552-1290 or write to us at [email protected]