CPT 97597, 97598 Removal of devitalized tissue from wound care

Jul 10, 2021 | Medical billing basics

CPT code and Description

Two for One The new CPT book redefines active wound care. The instructions now read: Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing. Provider is required to have direct (one on-one) patient contact. Note that the italicized text above is new for this year.

In addition to the new instructions, CPT code 97601 has been deleted. In its place, there are two new codes: 97597 and 97598. They are defined as follows:

• 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 wounds(s) surface area less than or equal to 20

• 97598 total wound(s) surface area greater than 20 square centimeters. Providers must select one code or the other from the pair, based on the surface area treated. Medicare allowed amounts are a little less for 97597 (RVU 1.27) than for 99213 (RVU 1.39), and a bit less for 97598 (RVU 1.64) than for 99202 (RVU 1.72).


There is still no reimbursement (0 RVU) for 97602, Removal of devitalized tissue from wound(s), non selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.

Billing Guidelines wound Care (CPT Codes 97597, 97598 and 11042-11047)

  1. Active wound care procedures are performed to remove devitalized and/or necrotic tissue to promote healing. Debridement is the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed. These services are billed when an extensive cleaning of a wound is needed prior to the application of primary dressings or skin substitutes placed over or onto a wound that is attached with secondary dressings.
  2. Typically bill CPT 97597 and/or CPT 97598 for recurrent wound debridements when medically reasonable and necessary.
  3. CPT 97597 and/or CPT 97598 are not limited to any specialty as long as it is performed by a health care professional acting within the scope of his/her legal authority.
  4. CPT code 97597 and 97598 require the presence of devitalized tissue (necrotic cellular material). Secretions of any consistency do not meet this definition. The mere removal of secretions (cleansing of a wound) does not represent a debridement service.
  5. The use of CPT codes 11042-11047 is not appropriate for the following services: washing bacterial or fungal debris from lesions, paring or cutting of corns or calluses, incision and drainage of abscess including paronychia, trimming or debridement of nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. Providers should report these procedures, when they represent covered, reasonable and necessary services, using the CPT codes that describe the service supplied.
  6. When hydrotherapy (whirlpool) is billed by a physical therapist with CPT codes 97597 or 97598, the documentation must reflect the clinical reasoning why hydrotherapy was a necessary component of the total wound care treatment for removing of devitalized and/or necrotic tissue. The documentation must also reflect that the skill set of a physical therapist was required to perform this service in the given situation.
  7. Separate billing of whirlpool (97022) is not permitted with 97597-97598 unless it is provided for a different body part than the wound care treatment body part.
  8. Local infiltration, such as a metatarsal/digital block or topical anesthesia, is included in the reimbursement for debridement services and is not separately payable. Anesthesia administered by or incident to the provider performing the debridement procedure is not separately payable.
  9. CPT Codes 97597 and 97598 are considered “sometimes” therapy codes. If billed by a physical therapist when the patient is under a home health benefit, it may be covered by the Home Health agency, if part of their Plan of Care. If it is a physician or nonphysician practitioner that is billing these “sometimes” therapy codes, it is paid under Part B even if the beneficiary is under an active home health plan of care. CMS Publication 100-02, Medicare Coverage Policy Manual, Chapter 7 – Home Health Services, Section 10.11 – Consolidated Billing, C. Relationship Between Consolidated Billing Requirements and Part B Supplies and Part B Therapies Included in the Baseline Rates That Could Have Been Unbundled Prior to HH PPS That No Longer Can Be Unbundled which states: Physician services or nurse practitioner services paid under the physician fee schedule are not recognized as home health services included in the PPS rates. Supplies incident to a physician service or related to a physician service billed to the Medicare contractor are not subject to the consolidated billing requirements.
  10. CPT code 97602 has been assigned a status indicator “B” in the Medicare Physician Fee Schedule Database (MPFSDB), meaning that it is not separately payable under Medicare.
  11. Documentation must support the HCPCS being billed.
  12. Payment for low frequency, non-contact, non-thermal ultrasound treatment (97610) is included in the payment for the treatment of the same wound with other active wound care management CPT codes (97597-97606) or wound debridement CPT codes (11042-11047, 97597, 97598). Low frequency, non-contact, non-thermal ultrasound treatments would be separately billable if other active wound management and/or wound debridement is not performed.
  13. Infrared (97026), ultra-sound thermal (97035), phototherapy-ultraviolet (97028) modalities are not payable per the LCD.

Coding Guidelines

  1. Debridement of a wound, performed before the application of a topical or local anesthesia is billed with CPT codes 11042 – 11047. Wound debridements (11042-11047) are reported by depth of tissue that is removed and by surface area of the wound. When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. See CPT coding guidance for proper use of the coding.
  2. Do not report 11042 -11047 in conjunction with 97597-97602 for the same wound.
  3. CPT code 11043, 11046 and 11044, 11047 may only be billed in place of service inpatient hospital, outpatient hospital or ambulatory surgical center (ASC).
  4. CPT codes 11043, 11046 and 11044, 11047 are codes that describe deep debridement of the muscle and bone

DEBRIDEMENT CODES NOT INVOLVING SUBCUTANEOUS TISSUE

• 97597 Removal of devitalized tissue from wounds, selective debridement, without anesthesia, wound assessment, topical applications, instructions for ongoing care, total wound surface area first 20 sq cm —May include scalpel, scissors, waterjet

• CPT 15002-15005 are NOT to be used for the removal of nonviable tissue/debris in chronic wounds left to heal by secondary intention. CPT 11042-11047 and CPT 97597- 97598 are to be used for this.

Multiple Levels of Debridement Coding Example:

The patient has five wounds. There is a superficial blister on the right 1st MTPJ, an ulceration that penetrates to subcutaneous tissue beneath the left second metatarsal head, an ulceration that penetrates to subcutaneous tissue on the right anterior leg, an ulceration with necrotic Achilles tendon exposed on the posterior right heel, and a lateral left fibular malleolus with bone exposed.

1) Debrided 2 x 3cm Right 1st MTPJ skin ulcer = 97597
2) Debrided 2 x 1cm subcutaneous ulceration plantar 2nd metatarsal head as well as the subcutaneous 5 x 4 right leg ulceration = total 22 sq cm = 11042 for the first 20 sq. cm. plus 11045 for additional 2sq. cm.
3) Debrided 7 x 4cm necrotic Achilles tendon ulceration = 11043 for the first 20 sq. cm. and 11046 for additional 8 sq. cm.
4) Debrided 0.5 x 0.5cm necrotic bone on the left lateral malleolus = 11044

CPT 97597 and 97598

CPT 97597

  • Debridement of open wound to level of epidermis/dermis total wound surface area less than or equal to 20 square centimeters
  • Debridement defined as:
  • High pressure waterjet with or without suction
  • Sharp selective debridement with scissors, scalpel, and forceps
  • ebridement should involve removal of:
  • Fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm

Remember TOTAL Wound Surface Area

  • One ulcer 4cm x 4cm of dermis removed
  • CPT 97597 one unit
  • Two ulcers: first 2cm x 2cm, second 4cm x 4cm of dermis removed
  • CPT 97597 one unit
  • Three ulcers: 2cm x 2cm, 3cm x 2cm, 2cm x 2cm of dermis removed
  • CPT 97597 one unit

CPT 97598

  • Add-on code to CPT 97597
  • To be used if over 20 sq. cm of dermis is removed
  • Debridement of open wound to level of epidermis / dermis each additional 20 square centimeters
  • Used WITH CPT 97957
  • No 51 modifier on CPT 97598 with CPT 97597
  • Never to be used alone

Examples

  • One ulcer 5 X 5 sq. cm.
  • CPT 97597 one unit
  • CPT 97598 one unit
  • Two ulcers: first 4 X 4, second 4 x 3 sq. cm.
  • CPT 97597 one unit
  • CPT 97598 one unit
  • Two ulcers: first 5 x5, second 5 x 4
  • CPT 97597 one unit
  • CPT 97598 two units
  • One ulcer 75 sq. cm.
  • CPT 97597 one unit
  • CPT 97598 three units
  • Fall under Medicare consolidated billing
  • Will not get paid if patient is in a facility on a Medicare Part A stay
  • Can try to contract with facility….good luck!
  • CPT 97597 up to 20 sq. cm Epidermis/Dermis
  • CPT 97598 each addl. 20 sq. cm.

Examples

  • Ulcer is 6cm x 5cm to depth of dermis and you debride 4cm x 4cm of tissue to dermis:
  • CPT 97597
  • Ulcer is 6cm x 6cm to depth of bone and you debride 4cm x 3cm of it to subQ
  • CPT 11042
  • One ulcer debride 2cm. x 2cm. to dermis and another debride 6cm. x 6cm. to muscle.
    CPT 97597 – 59 mod
    CPT 11043
    CPT 11046

Novitas 2017 Part B Physician Fee Schedule Non-Facility
CPT 97597: $81.73
CPT 11042: $126.93
CPT 11043: $249.05
CPT 11044: $343.86
All have Zero day global

CPT Coding – Active Wound Care Mgmt 97597-97598

The health care provider performs wound care management by using selective debridement techniques to remove devitalized tissue without anesthesia. Selective techniques are those in which the physician has complete control over which tissue is removed and which is left behind. Selective techniques include high-pressure waterjet with or without suction, and sharp debridement techniques using scissors, a scalpel, or forceps.

Another newer method of selective debridement is autolysis, which uses the body’s own enzymes and moisture to re-hydrate, soften, and finally liquefy hard eschar and slough. Autolytic debridement is accomplished using occlusive or semi-occlusive dressings that keep wound fluid in contact with the necrotic tissue. Types of dressing applications used in autolytic debridement include hydrocolloids, hydrogels, and transparent films. Wound assessment, topical applications, instructions regarding ongoing care of the wound, and the possible use of a whirlpool for treatment are included in these codes. Report 97597 for a total wound surface area less than or equal to 20 sq. cm and 97598 for a total wound surface area greater than 20 sq. cm. Report the appropriate code per session

Coding Differs by Type of Debridement and Performing Clinician

Any code in CPT can be utilized to describe a clinical procedure or service rendered by any provider whose scope of practice includes that service.
Debridement is reported based on the type of debridement performed, surgical versus non-surgical, and the clinical professional who performs the procedure.5
Codes for surgical debridement are used only by physicians and non-physician practitioners (e.g., NP or PA) acting within their scope of licensure.

Codes for non-surgical debridement, 97597–97602 (Active Wound Care), are typically used by non-physician professionals such as physical therapists and occupational therapists. Physicians (and non-physician practitioners who are qualified to do so) generally use a surgical debridement code instead.

This section provides coding instructions for surgical debridement of burn wounds and non-burn wounds by physicians or nonphysician practitioners (NPPs) only.
(Dressings are discussed in a separate discussion entitled “Dressing Change” in another part of this section.) Debridement may be reported for a burn wound or for a different condition6using the code(s) that most accurately describes the procedure performed.

K E Y P O I N T

Non-physician professionals (e.g., PT, OT), licensed to perform nonsurgical debridement, should use Active Wound care codes 97597–97602 for burn wound debridemen

Debridement, Non-Surgical (97597-97598, 97602)

The following section is divided into these topics:

• Burn Wounds—Debridement, Non-Surgical, by Non-Physician Professionals (PT, OT)
• Non-Burn Wounds/Conditions—Debridement, Non-Surgical, by Non-Physician Professionals (PT, OT)

• CPT codes 97597–97602 are used to report these active wound care services as provided by physical therapists, occupational therapists, and enterostomal therapy nurses

• Surgical debridement codes 11042–11047 may not be reported in addition to 97597–97602 by the non-physician professional. Wound debridement performed by physicians
or non-physician practitioners acting within scope of licensure is reported using 11000-11001, 11004–11008 or 11042–11047 and, for burn wounds, 16020–16035.

• Application and removal of any protective or bulk dressings are included in codes 97597–97602.

• At this time, Medicare does not consider non-selective debridement (97602) a skilled service and bundles it into other services provided on the same day. Other government programs may follow Medicare’s payment guidelines.

• Other payers may allow reporting and payment for both services.

For coding non-surgical debridement as performed by nonphysician professionals (PT, OT), refer to the section entitled Debridement, Non-Surgical (97597-97602), which follows in sequence immediately after this discussion on surgical debridement.

Codes for non-surgical debridement, 97597–97602 (Active Wound Care), are typically used by non-physician professionals such as physical therapists and occupational therapists. Physicians (and non-physician practitioners who are qualified to do so) generally use a surgical debridement code instead.

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