Orthopedic Coding Alert

Question: Can our in-office nursing staff report 97597-97598 for selective debridement? I-ve heard a lot of conflicting advice on these codes. For instance, I-ve been told that only therapists can bill for the services.


Florida Subscriber

Answer: The short answer to your question is yes, under narrow circumstances--and depending on your payer--your nursing staff can report selective debridement using 97597-97598. But you probably won't get paid.

In CPT 2005, the AMA released 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).

According to the June 2005 CPT Assistant, these codes are limited to nonphysician professionals (such as physician assistants, nurse practitioners, enterostomal therapy nurses, wound care nurses, physical therapists, etc.) who are licensed to performed these procedures. 

Soon thereafter, CMS released transmittal 515 (www.cms.hhs.gov/manuals/pm_trans/R515CP.pdf), which stated that codes 97597-97598 represent therapy services except when -They are billed by providers of services who are not therapists, i.e., physicians, clinical nurse specialists, nurse practitioners and psychologists.- CMS guidelines, at least, do not limit 97597-97598 only to therapists.

Several other payers took a different stance. First Coast Service Options (a Part B payer in Florida), for instance, issued policies stating that 97597-97598 are exclusively for physical therapists, occupational therapists, or enterostomal nurses.

All this means one thing: Don't make a move on 97597-97598 until you check with your individual payer.

In addition, the National Correct Coding Initiative bundles 97597-97598 into codes for dozens of procedures, including debridement 11010-11012, burn treatments 16000-16035, and more than 90 codes specific to surgical practices--such as incision and drainage (10060-10061), wound repairs (12001-13160) and tissue transfers (14000-14350), among others. Therefore, you wouldn't report 97597-97598 separately at the same time as any of  these procedures.

Even if your nurses are eligible to report these selective debridements, you probably won't get paid. Medicare has designated 97597-97598 as -status C,- or carrier-priced, codes. In practice this means that to control costs, most carriers will not reimburse for the codes at all.

Remember: If your surgeon performs debridement, you can look to 11040-11044 for reporting and reimbursement. Nonphysician staff usually cannot report these codes, however (check with your state scope-of-practice guidelines).