97598 CPT Code: Know Your Codes

October 5, 2020Wound Care

Basics of 97598 CPT Code

+97598 CPT Code: Use 97598 in conjunction with 97597 for each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure). 97597 CPT Code is described as ‘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.’

Description of Procedure (97598)

Additional topical or local anesthesia is administered, as needed. Additional wound cleansing is performed, including additional removal of proteinaceous slough, fibrin, and debris covering the wound bed with curette, scalpel, and forceps or scissors until healthy tissue is visualized. CPT codes 97597 and 97598 are used for wet-to-dry dressings, application of medications with enzymes to dissolve dead tissue, whirlpool baths, minor removal of loose fragments with scissors, scraping away tissue with sharp instruments, debridement with pulse lavage, high-pressure irrigation, incision, and drainage.

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 a 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.

Example of +97598 CPT Code

• One ulcer 5 X 5 sq. cm.
  • CPT 97597 one unit
  • CPT 97598 one unit
• Two ulcers: first 4 X 4, second 4 x 3 sq. cm.
  • CPT 97597 one unit
  • CPT 97598 one unit
• Two ulcers: first 5 x5, second 5 x 4
  • CPT 97597 one unit
  • CPT 97598 two units
• One ulcer 75 sq. cm.
  • CPT 97597 one unit
  • CPT 97598 three units

A 28-year-old man presents with a chronic open wound on the right lower leg 3 cm above the medial malleolus. The patient previously underwent extensive debridement of the necrotic soft tissue at the site. The wound currently measures 6.3 cm x 5.2 cm x 2.2 cm. The wound bed is granulating but covered with adherent, yellow proteinaceous slough, and fibrous tissue. A moderate amount of serosanguineous drainage is noted. X-rays are unremarkable for bone changes. After examining the wound, it is determined that selective active wound care management would be appropriate.

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We hope that this article has provided basic guidelines about the 97598 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]