Primary Care Coding Alert

Question: Our provider just saw a patient who had a superficial linear abrasion that extended from below the patient’s left knee to just above the left ankle. Our provider minimally debrided the patient’s skin using a metal curette but only down to the dermis layer, then dressed the wound with Xeroform^®, gauze, and compression wrap. I cannot find a code that matches what the provider has performed. Does this mean my only option in this situation is to bill for an evaluation and management (E/M) service, or is there another code I can use to describe what the provider did?

Codify Subscriber

Answer: You are correct in saying that you cannot use any of the current wound-debridement codes in the 11042-+11047 section of CPT^®, as they describe wound debridement at much greater depths (subcutaneous in the case of 11042-+11045, muscle and/ or fascia in the case of 11043-+11046, and bone in the case of 11044-+11047) than your provider performed in this encounter.

But you don’t have to describe your provider’s work with an E/M code. Instead, you can use 97597 (Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less) using add-on code +97598 (… each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) if the area debrided exceeds 20 sq. cm.

These codes more accurately describe the kind of active wound care management your physician has provided, as the intent of these procedures is “to remove devitalized and/or necrotic tissue and promote healing” according to the CPT^® guidelines that accompany the codes. Use of 97597/+97598 is also consistent with the parenthetical instruction following code 11042, which states, “(For debridement of skin [ie, epidermis and/or dermis only], see 97597, +97598).”