Basics of Wound Care
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. Common procedure codes (CPT) used while billing for wound care include wound care codes i.e., 97597, 97598, and debridement codes i.e., 11042 up to 11047. We referred to local coverage determination (LCD) for wound care as a reference to discuss billing guidelines for wound care in the year 2022.
Billing Guidelines for Wound Care
- Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing. The provider is required to have direct (one-on-one) patient contact. These procedures have a 0 global period. These codes include the use of topical applications, suction, whirlpool wound assessment, and instructions for ongoing care.
- Typically bill CPT 97597 and/or CPT 97598 for recurrent wound debridements when medically reasonable and necessary. CPT codes 97597 and 97598 are used for wet-to-dry dressings, application of medications with enzymes to dissolve dead tissue, whirlpool baths, minor removal of loose fragments with scissors, scraping away tissue with sharp instruments, debridement with pulse lavage, high-pressure irrigation, incision, and drainage. These codes involve the dermis and epidermis only.
- 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.
- CPT codes 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.
- Debridement of a wound, performed before the application of topical or local anesthesia is billed with CPT codes 11042 – 11047. Wound debridements (11042-11047) are reported by the depth of tissue that is removed and by the 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.
- Do not report 11042 -11047 in conjunction with 97597-97602 for the same wound. CPT codes 11043, 11046, and 11044, 11047 may only be billed in place of service inpatient hospital, outpatient hospital, or ambulatory surgical center (ASC). CPT codes 11043, 11046, and 11044, 11047 are codes that describe deep debridement of the muscle and bone.
- The use of CPT codes 11042-11047 is not appropriate for the services like 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.
- 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 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. Separate billing of the whirlpool (97022) is not permitted with 97597-97598 unless it is provided for a different body part than the wound care treatment body part.
- 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.
Medical Billers and Coders (MBC) is a leading revenue cycle company providing complete medical billing services. We referred CMS LCD document to discuss billing guidelines for wound care in the year 2022. By outsourcing your wound care billing, you don’t have to hire wound care billers and coders for your practice. For more assistance in billing for wound care, email us at: email@example.com or call us: 888-357-3226.
Reference: Billing and Coding Guidelines for Wound Care
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