CPT code and Description
97597 Removal of devitalized tissue from wounds, selective debridement, without anesthesia, wound assessment, topical applications, instructions for ongoing care, total wound surface area first 20 sq cm May include scalpel, scissors, waterjet
CPT code 97598 (Debridement [eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [eg, fibrin, devitalized epidermis and/or dermis, exudate, 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; each additional 20 sq cm, or part thereof) was identified by the RUC on a list of services that were originally surveyed by one specialty but are now typically performed by a different specialty.
Billing Guidelines
Wound Care (CPT Codes 97597, 97598 and 11042-11047)
- Active wound care procedures are performed to remove devitalized and/or necrotic tissue to promote healing. Debridement is the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed. These services are billed when an extensive cleaning of a wound is needed prior to the application of primary dressings or skin substitutes placed over or onto a wound that is attached with secondary dressings.
- Typically bill CPT 97597 and/or CPT 97598 for recurrent wound debridements when medically reasonable and necessary.
- CPT 97597 and/or CPT 97598 are not limited to any specialty as long as it is performed by a health care professional acting within the scope of his/her legal authority.
- CPT code 97597 and 97598 require the presence of devitalized tissue (necrotic cellular material). Secretions of any consistency do not meet this definition. The mere removal of secretions (cleansing of a wound) does not represent a debridement service.
- The use of CPT codes 11042-11047 is not appropriate for the following services: washing bacterial or fungal debris from lesions, paring or cutting of corns or calluses, incision and drainage of abscess including paronychia, trimming or debridement of nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. Providers should report these procedures, when they represent covered, reasonable and necessary services, using the CPT codes that describe the service supplied.
- When hydrotherapy (whirlpool) is billed by a physical therapist with CPT codes 97597 or 97598, the documentation must reflect the clinical reasoning why hydrotherapy was a necessary component of the total wound care treatment for removing of devitalized and/or necrotic tissue. The documentation must also reflect that the skill set of a physical therapist was required to perform this service in the given situation.
- Separate billing of whirlpool (97022) is not permitted with 97597-97598 unless it is provided for a different body part than the wound care treatment body part.
- Local infiltration, such as a metatarsal/digital block or topical anesthesia, is included in the reimbursement for debridement services and is not separately payable. Anesthesia administered by or incident to the provider performing the debridement procedure is not separately payable.
- CPT Codes 97597 and 97598 are considered “sometimes” therapy codes. If billed by a physical therapist when the patient is under a home health benefit, it may be covered by the Home Health agency, if part of their Plan of Care. If it is a physician or nonphysician practitioner that is billing these “sometimes” therapy codes, it is paid under Part B even if the beneficiary is under an active home health plan of care. CMS Publication 100-02, Medicare Coverage Policy Manual, Chapter 7 – Home Health Services, Section 10.11 – Consolidated Billing, C. Relationship Between Consolidated Billing Requirements and Part B Supplies and Part B Therapies Included in the Baseline Rates That Could Have Been Unbundled Prior to HH PPS That No Longer Can Be Unbundled which states: Physician services or nurse practitioner services paid under the physician fee schedule are not recognized as home health services included in the PPS rates. Supplies incident to a physician service or related to a physician service billed to the Medicare contractor are not subject to the consolidated billing requirements.
- CPT code 97602 has been assigned a status indicator “B” in the Medicare Physician Fee Schedule Database (MPFSDB), meaning that it is not separately payable under Medicare.
- Documentation must support the HCPCS being billed.
- Payment for low frequency, non-contact, non-thermal ultrasound treatment (97610) is included in the payment for the treatment of the same wound with other active wound care management CPT codes (97597-97606) or wound debridement CPT codes (11042-11047, 97597, 97598). Low frequency, non-contact, non-thermal ultrasound treatments would be separately billable if other active wound management and/or wound debridement is not performed.
- Infrared (97026), ultra-sound thermal (97035), phototherapy-ultraviolet (97028) modalities are not payable per the LCD.
Differ insurance fee schedule for CPT 97597, 97598
| Insurance | CPT Code 97597 | CPT Code 97598 |
|---|---|---|
| Medicare | $150 | $200 |
| Medicaid | $100 | $150 |
| UnitedHealthcare | $200 | $250 |
| Aetna | $175 | $225 |
| Blue Cross Blue Shield | $150 | $200 |
| Cigna | $175 | $225 |
| Humana | $150 | $200 |
| Oscar | $125 | $175 |
| Anthem | $150 | $200 |
Coding Guidelines
- Active wound care, performed with minimal anesthesia is billed with either CPT code 97597 or 97598.
- Debridement of a wound, performed before the application of a topical or local anesthesia is billed with CPT codes 11042 – 11047.
- CPT code 11044 or CPT code 11047 may only be billed in place of service inpatient hospital, outpatient hospital or ambulatory care center (ASC)
DEBRIDEMENT CODES NOT INVOLVING SUBCUTANEOUS TISSUE
Skin Preparation Codes
- The surgical preparation codes, CPT 15002-15005, “are to be used for the initial traumatic wound preparation (removal of appreciable nonviable tissue) and cleaning to provide a viable wound surface (primary intention healing) for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy.”
- CPT 15002-15005 are NOT to be used for the removal of nonviable tissue/debris in chronic wounds left to heal bysecondary intention. CPT 11042-11047 and CPT 97597- 97598 are to be used for this.
- CPT 15002-15005 are selected based on the anatomic area and size of the prepared/debrided defect. For multiple wounds, the choice of code is based on the aggregate sum of the surface area of all similarly grouped wound types
Physician Reimbursement
Medicare reimburses physicians according to the Medicare Physician Fee Schedule (MPFS), which is based on Relative Value Units (RVUs) and payment varies by geographical region.
Wound Care and Debridement are reported with CPT® codes 97597, 97598 and 11042-11047. Active wound care procedures are performed to remove devitalized and/or necrotic tissue to promote healing. Debridement is the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed. These services are billed when an extensive cleaning of a wound is needed prior to the application of primary dressings or skin substitutes placed over or onto a wound that is attached with secondary dressing