ED Coding and Reimbursement Alert

No longer call on 97601 for active wound care 

In 2005, when the physician removes a patient's devitalized tissue, you'll be able to report two new CPT codes that better describe the work and specify the wound's size - which should improve your practice's reimbursement for these services.
 
CPT 2005 introduces two codes:

   97597 - Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or  without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters

97598 - ... total wound(s) surface area greater than 20 square centimeters.

Typically, physicians perform this kind of debridement on diabetic wounds and pressure ulcers, says Bruce Rappoport, MD, CPC, who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP in Fort Lauderdale, Fla.
  
No more 97601: Codes 97597 and 97598 replace active wound-care code 97601 (Removal of devitalized tissue from wound[s]; selective debridement, without anesthesia [e.g., high-pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session), which CPT deletes for 2005.
  
The facts are still coming in: CPT had designed 97601 for nonphysician practitioner use, Rappoport says. CPT has not yet specified whether 97597 and 97598 are limited to physician use or whether other medical staff may also report the codes. However, one thing is clear, says Michael A. Granovsky, MD, CPC, FACEP, VP of MRSI in Stoneham, Mass.: "The CPT definition of  these codes includes a requirement for direct one on one patient contact."

Codes Reflect Extra Physician Work

Because the new codes specify the wound's size, you can easily report smaller debridements (97597) separately from larger ones (97598), says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare consulting firm in Denver.
  
The bottom line: Codes 97597 and 97598 allow physicians to report their work more accurately. Medicare assigns codes RVUs according to the amount of work the procedure requires, Hammer says. Therefore, if 97598 describes a large-wound debridement, you can expect more RVUs than Medicare assigns to 97601, which doesn't specify size.

Stop Worrying About Topical Applications

CPT has helped coders tremendously by including "with or without" topical applications in the descriptors, Hammer says.
 
Old problem: The physician doesn't provide topical applications as part of the debridement. Established code 97601's definition states, "including topical application(s), wound assessment, and instruction(s)." Many coders didn't know if this descriptor meant they couldn't report the code without topical application, or if they should attach modifier -52 (Reduced services).
  
New solution: The new codes now state "with or without topical application(s)," so you don't have to consider this method when choosing a code.

Know the Size Before You Know the Code

Before using 97597-97598, make sure the ED physician documents the wound's size. This critical information determines the codes you choose.
  
Remember that CPT specifies 97597 as representing wounds "less than or equal to 20 square centimeters," while 97598 describes wounds "greater than 20 square centimeters." Therefore, documentation that states the physician treated a "large wound" is too vague for you to correctly code the procedure.
  
Save yourself some time: Train your physician to measure the wound using the metric system, Hammer says. If the physician documents the wound as 1 x 2 inches, you'll have to convert this measurement into centimeters. But if you can convince the doctor to use centimeters, you can skip this step altogether.