97602 CPT Code: Know Your Codes
97602 CPT Code Description
Removal of devitalized tissue from wound(s), nonselective debridement, without anesthesia (e.g. wet-to-moist dressings, enzymatic, abrasion, larval therapy), including tropical application, wound assessment, and instructions for ongoing care, per session. 97602 CPT code is assigned a status of B under the Medicare Physician Fee Schedule (MPFS). When this service is provided by a discipline that receives reimbursement based on the MPFS, this code is not separately reportable or payable, meaning that it is not separately payable under Medicare. Instead, it is bundled into other procedures performed.
Meaning of ‘sometimes therapy’
The Addendum B updates on CMS’ website indicate that CPT 97602 is assigned to status indicator T (significant procedure, multiple reduction applies) under OPPS. The difference exists because this code denotes a ‘sometimes therapy’ procedure. A procedure designated as ‘sometimes therapy’ a qualified therapist (e.g. physical therapist) may perform under a therapy plan of care. When a qualified therapist provides the service, coders must report the service under a therapy revenue code with the appropriate therapy modifier (i.e., GP for physical therapist).
Payment for therapy services is based on the physician fee schedule; in this situation, CMS will bundle the payment for 96702 into other services provided. In contrast, when the service is provided in a hospital outpatient department, (e.g., by wound care nurses) it is reported as a hospital outpatient service and payable under the assigned APC for hospitals subject to OPPS.
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.
Documentation for 97602 CPT Code
For Non-Selective Debridement (CPT 97602) documentation to support non-selective debridement should include:
- Type of technique utilized i.e., wet-to-moist, enzymatic, abrasion.
- 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.
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