Eli's Rehab Report

Dressing changes and applications of creams or ointments are included in the reimbursement for 97601 and 97602 and should not be separately reported, says Janet Hulce, RN, MSN, CS, clinical nurse specialist at St. Luke's Cornwall Hospital in Cornwall, N.Y., and a national speaker on wound care for PESI Health Care.

If the practitioner performs a dressing change with ointment application and does not perform any debridement, 97601 and 97602 cannot be billed. "These codes apply exclusively to debridement," Hulce warns. "Putting on an outside bandage just to hold a patient's dressing intact is not counted as wound care or strapping."

Hulce says that strapping (29200-29280, 29520-29590) can be billed along with wound care. "Sometimes we bill four or five codes together, because patients with high levels of venous insufficiency [459.81] require several treatments at once, and we do get paid for all of it."

For instance, Hulce says, a patient may present with a leg wound that requires a nurse's evaluation (CPT 99211 ), selective debridement (97601), electrical stimulation (97032) and application of an Unna boot (29580). "Of course, your documentation system has to be pristine so you can justify billing for so many procedures together, but if you perform them, you should bill them."

The patient's chart should include any changes in the wound size or condition since his last visit, as well as any problems with his dressing materials or changes in medication. The clinician should clearly note the location of the wounds, with drawings of the wound sites, if possible. Sometimes, CMS denies ongoing claims for wound care, stating that frequency guidelines have been exceeded. However, if your chart clearly documents that the wound appears smaller and healthier at each visit, you may be able to appeal for more time to treat it. The chart should also note the exact type of debridement used and the types of dressings applied.

The code descriptors for 97601 and 97602 refer to "wound(s)," which means the code should be billed only once despite the number of wounds treated.

When physiatrists perform debridement, the code series 11040-11044 should be billed. Not only do these codes reimburse higher than 97601-97602 (see chart below), they can also be billed more than once per session. For instance, if a physiatrist debrides partial-thickness wounds on a patient's left arm and left thigh, she can bill 11040 twice, with modifier -59 (Distinct procedural service) appended to the second site.