General Surgery Coding Alert

Incorrect 97597-97598 claims could mean up to $250 less

For your surgeon's debridement services, you should turn to integumentary system codes 11000-11044 rather than size-based wound care codes 97597-97598.
 
Reason: Several months after CPT released 97597-97598, payers have decided that you shouldn't bill these services for surgeons or other physician providers. Check Eligibility Before Reporting 97597-97598 Although 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) and 97598 (... total wound[s] surface area greater than 20 square centimeters) allow you to code based on the diameter of the debrided wound, the codes are intended only for nonphysicians, says Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.

Some carriers have further restricted use of 97597-97598 to physical therapists, occupational therapists, or enterostomal nurses.

No surprise: Codes 97597 and 97598 replaced 97601 in the 2005 CPT manual, and payers treated 97601 as a nonphysician service, as well. Don't Settle for Less Than You're Due If you do report 97597-97598 for surgeon services, you may not receive a denial, but you'll almost certainly lose money, Rappoport warns.
 
For example: Reimbursement averages $50 for 97597. In contrast, payment for 11040 (Debridement; skin, partial thickness) averages $42.59 (based on national Medicare payments), but surgeons are more likely to bill 11041 (...skin, full thickness) - which pays $62.62 - or even 11042 (... skin, and subcutaneous tissue) - which pays $87.71. And, 11044 (... skin, subcutaneous tissue, muscle and bone), the highest-paying debridement code, reimburses a total of $310 in Florida, Rappoport says. If you settle for 97597 when you should report 11044, you're losing serious money. Include Dressing Changes in E/M If you're thinking of using 97597 for bedside dressing changes because the descriptor specifies that the patient doesn't receive anesthetic, think again. You should never use a debridement code for anything other than actual wound care, Rappoport insists.

In addition, you shouldn't charge separately for a dressing change. "This service is included in any evaluation and management services provided," Rappoport says.

There are two other crucial differences between 11040-11044 and 97597-97598, says Christine Lufkin, coding specialist with Medical College of Wisconsin.
 
The descriptors for 97597-97598 specify that the patient receives no anesthesia during the debridement, and 97597-97598 include a high-pressure waterjet or suction device.

Learn more: For further information on 97597 and 97598, see "Size-Specific Wound-Care Codes Mean More Specific Payment [...]