General Surgery Coding Alert

General surgery practices looking forward to reporting new-for-2005 size-specific wound care codes now need to rein in their enthusiasm. You won't be able to report 97597 and 97598 with certain debridement and burn care codes, and a slew of wound repair codes.
 
The latest National Correct Coding Initiative (NCCI, version 11.0) will prevent you from billing 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) with dozens of procedures, including debridement codes 11010-11012 and burn treatment codes 16000-16035.
 
And NCCI now bundles 97597 and 97598 to hundreds of other codes, including more than 90 codes specific to general surgery practice - such as incision and drainage (10060-10061), wound repairs (12001-13160), and tissue transfers (14000-14350), among others.

Double-Check for Edit Combinations

Although 97597 and 97598 continue to have advantages over the only other previous choice for wound care - 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 deleted for 2005 - you'll have to be extra cautious when reporting wound care with so many NCCI edits now aimed at 97597 and 97598.
 
"Coding for wound care has always had a lot of challenges associated with it, some of which we thought would be solved with the new codes [97597 and 97598]. But clearly the challenges continue as this latest round of NCCI edits creates another level of difficulty coders will need to watch out for," says Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.
 
Bottom line: If you're going to bill for wound care using 97597 or 97598, be sure that the codes aren't bundled to or considered mutually exclusive of other services the surgeon provides for the same patient at the same encounter. 
 
Learn more: For more information on 97597 and 97598, see "Size-Specific Wound Care Codes Mean More Specific Payment for Your Practice," General Surgery Coding Alert, January 2005, pp. 1-2.