General Surgery Coding Alert

Question: We have always used the 11000-series codes for wound debridement, but recently I noticed 97601 and 97602. Should we use 97601-97602 in place of 11040-11044?

General Surgery Discussion Group Participant Answer: Active wound-care management codes 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) and 97602 ( non-selective debridement, without anesthesia [e.g., wet-to-moist dressings, enzymatic, abrasion] ) were developed by the AMA CPT editorial panel for inclusion in CPT 2001. In 2002, the CPT panel clarified that these codes were intended to report treatment provided through an entire treatment session, regardless of the number of wounds or wound areas treated at the session. Codes 97601 and 97602 should be used to report wound-care procedures performed only by nonphysicians licensed to perform the procedures (e.g., physician assistants, nurse practitioners, wound-care nurses, physical therapists), and therefore are not a direct replacement for 11040-11044, which describe wound-care debridement performed by a physician.

If, for example, a patient presents with necrotic tissue on the left thigh and the surgeon debrides the area from the skin to the subcutaneous tissue, 11042 (Debridement; skin, and subcutaneous tissue), rather than 97601, is appropriate.

Note that CMS has bundled 97602 into 97601 and has not established any work relative value units for 97602. CMS has stated that the services described by 97602, including removal of devitalized tissue, are included in the work and practice expense values for 97601.