Medicare Compliance & Reimbursement

FAQ addresses coding conventions for wound care Patients who present to your practice for debridement pose a challenge for coders because there are misconceptions floating around about how to properly assign active wound care management (AWCM) codes 97597-97598. Add to that the confusion regarding selective versus surgical debridement, and you have a potential coding challenge on your hands. Question: Who can provide the 97597-97598 service? Answer: Nonphysician practitioners (NPPs) licensed to perform these procedures (for example, physician assistants, nurse practitioners, physical therapists) typically report 97597-97598. CPT designed 97597 (Removal of devitalized tissue from wound[s], selective debridement ... 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) for reporting by licensed nonphysician professionals. Because licensure and state laws vary from state to state, you'll have to check your individual policies to see what "qualifies" an NPP to perform these debridements. Note: Most physicians do not directly perform these debridement services. But if they do, check your contracts to make sure the payer accepts 97597-97598 when the physician performs the service. Remember to use 97597-97598 only for encounters during which the provider meets the codes' parameters, says Sharon Richardson, RN, compliance officer with Emergency Groups' Office in Arcadia, CA. Question: What are the parameters for 97597-97598? Answer: When the wound management provider performs selective debridement on a patient, you would code the service with 97597, says Jeffrey Linzer, MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine Department of Pediatrics at Children's Healthcare of Atlanta at Egleston. Selective debridement means removing devitalized tissue from the wound, Richardson says. During selective debridement, the provider does not treat any healthy tissue, only the devitalized tissue. Check out this definition from Diversified Clinical Services, a consulting firm in Jacksonville, FL. Note how the definition specifies "devitalized tissue": "Selective debridement is the removal of devitalized tissue (including fibrin, exudates, crusts, and other non-tissue materials) from wounds, without general anesthesia (e.g., high-pressure water jet with/without suction, sharp selective debridement with scissors, scalpel, or forceps), with or without topical applications." "It's basically removal of dead tissue that is sitting on top of the wound and keeping it from healing," Richardson says of selective debridement. Remember that your provider might use aggressive means of tissue removal for this service, including scissors, curettes, water pressure, etc. No matter the tools of removal, the service is still a selective debridement as long as the provider is not treating healthy tissue, Richardson says. Consider this example from Linzer: A patient who recently underwent treatment for a 2-cm x 2-cm infected carbuncle on the back of his hand [...]