ED Coding and Reimbursement Alert

Question: Our provider saw a patient who had a superficial linear abrasion that extended from below the patient’s left knee to just above the left ankle (in addition to several left knee and lower-leg injuries). The ED physician minimally debrided the patient’s skin using a metal curette but only down to the dermis layer, then dressed the wound with Xeroform®, gauze, and compression wrap. I cannot find a code that matches what the provider has performed. Does this mean my only option in this situation is to bill for an E/M service, or is there another code I can use to describe what the provider did?

North Carolina Subscriber

Answer: You are correct in saying that you cannot use any of the current wound debridement codes from the 11042-+11047 section of CPT^®, as they describe wound debridement at much greater depths (subcutaneous in the case of 11042-+11045, muscle and/ or fascia in the case of 11043-+11046, and bone in the case of 11044-+11047) than your provider performed in this encounter.

But you don’t have to describe your ED physician’s work with an E/M code. Instead, you can use 97597 (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; first 20 sq cm or less) along with add-on code +97598 (… each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) if the area debrided exceeds 20 sq. cm.