Wiki Help with 97597

[splaineduchsherer]

New to Podiatry and suprised how many claims I am getting back for 97597,,, not medically necessary? These are patients with the diagnosis of diabetes, neuropathy etc
We are using Athena software and am wondering if this is an Athena denial or a medicare denial.

Anyone have anything to offer on this. Thanks much

 

[Orthocoderpgu]

Really need more information

Debridement is one of those codes that is just problematic by nature. If all your billing for is debridement, there should not be much problems getting it paid. If you are billing it with other procedures, the insurance will almost always deny as being bundled.

If you are billing 97597 for diabetic skin lesions and they are not getting paid, I would refer to your LCD to see if you can't come up with a better diagnosis code to submit with it.

Two cents.

 

[browninge]

I had the same issue. I found out that they were looking for the chart notes to support the code. I found that if I send paper claims with the chart note to Medicare they usually pay them with no issue. Hope this helps.