Home health, clinic, skilled nursing facilities, and hospital services involve the need for precise wound care documentation and coding. The cleaning, dressing, and debridement of an acute and chronic wound are covered by wound care services for assessment of treatment of the wound.  The specific wound care CPT code involves the selective debridement code 97597 and the non-selective debridement code 97602, as well as 97605 and 97606 for negative pressure treatments.

It is vital to be aware of the facts about each of the Wound Care CPT codes that medical coders and healthcare professional’s use in a medical coding company in USA. The services that are billed using the code Wound Care are expected by Medicare and other insurers. Therefore, healthcare professionals are able to prevent common billing errors with the use of the Wound Care Codes. This blog will provide comprehensive billing and coding guidelines regarding wound care CPT codes. 

Understanding Wound Care Procedure Codes

Wound care services differ in their complications. Accuracy of reporting is dependent on applying the right codes for services involving wound care. The guidelines on coding in wound care certify compliance in reporting services such as debridement, and all other innovative forms of treatments. You need to learn also about code ICD-10 M79.605 for left leg pain that combines it with the correct CPT codes to check on the appropriate claims and reimbursement process.

Description of Wound Care Procedure Codes

The following facts express the wound care procedure codes:

• Wound care procedure codes describe expert medical services provided to treat acute or chronic wounds.
• These codes reflect physician or qualified medical professional involvement.
• Commonly used CPT wound care procedures codes are 97597, 97602, 97605, and 97606.
• The depth of the wound,  size, type of tissue, and the approach to therapy are used to determine the codes.
• Use of the proper code ensures alignment with payer reimbursement policies.
• Documentation must evidently relate the procedure to specific wound conditions of the patient.

Differences Between Active Wound Management and Routine Care

The following evidences describe differences between active wound management and routine care:

• Active wound management entails medical judgment and expert intervention.
• CPT codes such as 97597 and 97602 indicate active debridement services.
• Routine wound care like simple cpt code for wound dressing changes or cleansing is habitually not separately billable.
• Expert services include infection management, tissue removal, or advanced therapies or treatments.
• Active care must show medical necessity or assessable progress.
• Clear documentation differentiates skilled wound care from custodial care.

When Wound Care Coding Is Medically Necessary

The following indication highlights when wound care coding is a medical necessary in medical coding services:

• Wound care coding is suitable when the wound impairs or damages healing or function.
• Medical necessity is established through clinical results and treatment goals.
• Diabetic ulcers, Pressure injuries, and non-healing surgical wounds are some conditions that can be qualified.
• Negative pressure wound therapy requires CPT procedures codes include  97605 and 97606. 
• There is a need to record wound measurements, tissue type, and response to treatment.
• Adhering to wound care coding guidelines supports to prevent denials and audits. 

Pro Tip: Wound care procedures should always be coded on the basis of medical complexity, skilled versus non-skilled procedures, and not simply on the procedure itself. Proper documentation of the depth, tissue, measurements, and response of the wound will eliminate non-compliance issues related to denial.

Commonly Used Wound Care CPT Codes

Wound care services are billed in a way that involves careful code selection based on the level of care. Training in the most common wound care CPT codes used in the billing of wound care services of a patient supports the use of appropriate wound care billing codes based on the level of the patient’s wound. You must know that precise ICD-10 coding for lower back pain-from unspecified to chronic-allows support for medical necessity and provides a smooth flow toward CPT codes for billing.

Overview of Frequently Reported Wound Care CPT Codes

The following overview presents commonly used wound care CPT codes and guidance outlines selecting codes based on wound type and depth:

• CPT 97022 is a code used for whirlpool therapy as part of wound care and must be clinically justified.
• CPT 97026 is a code used for infrared therapy and not payable separately per LCD.
• CPT 97028 is a code used for phototherapy and ultraviolet and not payable separately per LCD.
• CPT 97035 is a code used for ultrasound, thermal and not separately payable for wound care.
• CPT 97597 is a code for selective debridement of devitalized tissue or chronic or non-healing wound like the first 20 sq cm or less.
• CPT 97598 is code for each additional 20 cm² of superficial debridement.
• CPT 97602 is a code for non-selective debridement for wounds that remove the tissues.
• CPT 97605 is a code for negative pressure wound therapy (NPWT) for smaller chronic wounds or ≤ 50 sq cm.
• CPT 97606 is a code used for NPWT for larger chronic wounds or > 50 sq cm.
• CPT 97607 is code used for advanced wound care with specialty dressings or skin substitutes.
• CPT 97608 is code used for additional wounds using advanced wound care techniques.
• CPT 97610 is code that denotes a procedure  like MIST therapy for wound healing rather than debridement. 
• CPT 99212 is code used for low complexity E/M visits for an established patient for  minor wound treatment.
• CPT 99213 is a code used for moderate complexity E/M visit and treatment plan adjustments.
• CPT 99214 is code used for high complexity E/M visit and detailed assessment of complex wounds.
• CPT 99215 is code used for highest complexity E/M visit and comprehensive evaluation of severe or chronic wounds. 
• CPT 11042 is a code used for debridement of subcutaneous tissue and is reported by depth and surface area.
• CPT 11043 is code used for deep debridement of muscle, limited to inpatient and outpatient, or ASC.
• CPT 11044 is a code used for debridement of bone and is reported by depth and surface area, and hospital or ASC only.
• CPT 11046 is code used for additional muscle tissue debridement and hospital or ASC only.
• CPT 11047 is code used for additional bone debridement, hospital or ASC only.
• CPT 15271 is  a code used for skin substitute procedures on the arms, trunk, or legs to cover a wound up to 100 cm2 in size.
• CPT 15274 is code that is used to denote area and age-specific skin substitute procedure.
• CPT 15278 is code that covers an add-on skin substitute procedure.
• These are the codes that apply to chronic, non-healing, or complex, or high complex or complicated wounds.
• Each code represents different levels of skill, time, and clinical decision-making.

CPT 97597: Selective Wound Debridement

CPT 97597 is one of the most regularly reported CPT codes for wound care and is applied to describe a selective debridement service which requires expert clinical judgment. Proper use of this code promises appropriate reimbursement whereas remaining compliant with established standards for billing and documentation for wound care.

Effective denial management services must integrate with accurate CPT and HCPCS codes to analyze denial data in order to maximize denial reversal results and root out the cause of denial.

97605 CPT Description

• CPT 97597 is a code used for selective debridement or devitalized tissues.
• Engages in the removal of necrotic tissue including slough, fibrin, or biofilm.
• Performed with instruments such as forceps, scalpels, scissors, or curet.
• Made to order for the first 20 square centimeters or less.
• Needs active provider and personal intervention.
• Commonly used in chronic wounds and nonhealing ulcers.

Indications for Selective Debridement

• There is non-viable or dead tissue present that delays the healing process of the wound.
• Chronic wounds such as diabetic foot ulcers or pressure ulcers.
•  Infections or contamination that need tissue elimination.
• Wounds that have sufficient blood supply to their base to support the healing process.
• Failure of conservative methods of wound care.
• Medical necessity supported by a patient-specific wound assessment.

Documentation Requirements

• Comprehensive description of the injuries location and features.
• Measurement of the wound size and surface area.
• Tissue removed in the process of debridement.
• Tools and techniques employed for selective debridement.
• Patient response and procedure tolerance.
• Ongoing treatment and healing goals.

Billing Considerations and Common Errors

• CPT 97597 should not be charged in cases of wound cleaning.
• CPT code for wound dressing changes alone are not reasons to assign this code.
• Lack of recording of wound sizes may result in denials.
• Overuse without a clear necessity raises concerns about audibility.
• Also required to abide by payer guidelines.
• Linkage between documentation and CPT code 97597 has to be accurate.

Pro Tip: Code 97597 should only be submitted when a record indicates selective debridement, while the removal of devitalized tissue requires a measurable wound area, and this should not be submitted for routine cleansing or dressing changes.

CPT 97602: Non-Selective Wound Debridement

CPT Code 97602 is utilized for non-selective debridement of wounds, which assist in the healing process but do not require as much expertise as in selective debridement procedures. Proper use of this CPT Code will ensure that there are no violations of the rules applicable for CPT Code Wound Procedures.

Explanation of 97602 CPT Code

• CPT 97602 describes non-selective debridement of devitalized tissue.
• Tissue is removed by techniques including wet-to-dry dressings, enzymatic agents, or irrigation.
•  Does not involve direct removal of tissues by sharp instruments in a skilled manner.
• Usually performed by clinical staff according to predefined protocols of care.
• Applied to wounds that contain necrotic tissue which does not require selective debridement.
• Represents or reflects a lower level of clinical complexity than CPT 97597.

Clinical Scenarios for Non-Selective Debridement

• Chronic or severe wounds with superficial necrotic tissue.
• Pressure injuries in early stages of treatment.
• Post-surgical wounds require gradual tissue removal.
• Patients unable to tolerate sharp or selective debridement.
• Wounds responding to conservative debridement methods.
• Situations where skilled selective debridement is not medically necessary

Billing Rules and Limitations

• 97602 CPT code is typically billed per session, regardless of wound size.
• Often considered a bundled service by many players.
• Not payable on the same date as selective debridement for the same wound.
• Must be supported by documentation showing medical necessity.
• Routine care of a wound without active debridement cannot continue to be reimbursed.
• It is important to adhere to the specific billing requirements for wound care to prevent rejection.

Negative Pressure Wound Therapy CPT Codes

Negative pressure wound therapy CPT Codes are described as:

CPT 97605: NPWT ≤ 50 sq cm

The clarification listed under CPT code 97605 relates to Negative Pressure Wound Therapy services accomplished on a wound that measures 50 square centimeters or less. This specific code applies when controlled pressure has been applied to support in wound healing via the removal of exudation, reduction of edema, and promotion of granulation tissue. CPT Code 97605 applies to chronic, non-healing wounds such as foot ulcers, pressure ulcers, and post-surgical ulcers, when said services are considered to meet certain criteria.

From a billing viewpoint, the preferred billing of CPT 97605 involves each wound, each session, with a requirement for a record of the wound dimensions, the nature of the wound, as well as the response of the wound to treatment. Payer policies apply to the benefits, but most insurance programs require documentation of the failure of standard wound treatment procedures as well as the appropriateness of NPWT.

CPT 97606: NPWT > 50 sq cm

The CPT code “97606” is utilized for reporting the services of negative pressure wound therapy provided for a wound that measures more than 50 square centimeters. The complexity and time involved for a larger surface area are captured accurately by CPT code “97606,” which, similar to CPT code “97605,” promotes the advanced healing of a wound using continuous or intermittent negative pressure provided by qualified personnel.

The reproduction of 97606 cpt code requires precise measurement of the wound and complete documenting by the practitioner. The dimensions of the wound and the entire surface area treated need to be documented by the practitioner. The differences in the code based on the dimensions of the wound for 97605 and 97606 are strictly implemented by insurance companies for the purpose of correct reimbursement.

Pro Tip: When providing NPWT, it is a reminder that total wound surface area should always be measured and recorded accurately because there is a significant difference between CPT codes 97605 (for total surface area up to and including 50 square centimeters) and CPT code 97606 (for total surface area greater than 50 square centimeters). It is critical that a failure of traditional treatments and a clinical response to treatment have been demonstrated.

Wound Dressing CPT Codes

Wound dressing services are common in the management of a wound, but they may not always qualify for reimbursement using a CPT code specific for the service. However, CPT coding for wound dressing services is always done when the process involves skilled services that require clinical decision-making. 

Simple or standard dressing services, such as the application of a simple gauze dressing or a simple bandage change, are not reimbursable, while skilled wound dressing services require proper documentation to qualify for reimbursement according to CPT guidelines. The CPT code for debridement (97597, 97602) or negative pressure therapy (97605, 97606) includes the service of wound dressing. The CPT code for a wound dressing service is applicable when the service is not included in the CPT code for other services.

Overview of Frequently Reported Wound Care CPT Codes

Wound Care Billing Guidelines

Following established rules and regulations in wound care billing is crucial to ensure proper reimbursement and correctness. Wound care coding helps ensure that wound care services are properly coded in accordance with established rules and policies of the insurance organization and the nation.

• It must be medically necessary, with its appropriateness supported by clinical documentation for any wound care service to be valid.
• The type, extent, size, and complexity of the wound need to be captured in the CPT coding.
• The National Correct Coding Initiative (NCCI) edits identify whether wound care services should be billed or bundled separately.
• Debridement, evaluation, and or therapy codes usually include routine care for the wound.
• Justification is needed for services performed, with modifiers applied when indicated.
• The use of negative pressure wound therapy (97605, 97606), while having certain frequency and coverage guidelines,
• Failure to follow the rules of billing for care of the wound can lead to claim denials or audits.

Wound Care Coding Guidelines and Documentation Tips

Care needs to be appropriately billed and supported by the principles of medical necessity in order to secure proper reimbursement. The result can be achieved by following the established coding standards for wound care services.

• Record the type of wounds, locations, or etiology involved with each encounter.
• Accurate recordings of wound size measured by length, width, depth, and total surface area.
• Must evidently indicate tissue involvement such as either necrotic, slough, infected tissue and granulation.
• Provide linkages or connections between the results that were found and CPT codes like 97597, 97602, 97605, and 97606. 
• Do not under code. Record skilled services properly.
• Prevent over coding by not reporting routine care of wounds as skilled treatment.
• Keep progress notes on the reaction to treatment and the outcomes of healing.

Common Wound Care Billing Errors to Avoid

Proper billing of wound care services is highly necessary in order to achieve precise reimbursement and appropriate use of wound care coding guidelines or rules. Misuse of codes mostly leads to denied claims, lost revenue, audits. Therefore, it is essential to produce understanding about proper usage of wound care CPT codes.

• Placing the incorrect CPT code (97597 vs. 97602) for selective versus non-selective debridement.
• Failing to record or document wound size, depth, or tissue type required for billing.
• Reporting routine dressing changes instead of expert wound care like cpt code for wound dressing.
• Do not misuse NPWT codes as applying 97605 for wounds >50 sq cm or 97606 cpt code for smaller wounds.
• Billing multiple codes for the same wound session without clinical justification.
• Not following coverage rules for NPWT or debridement such as ignoring payer-specific guidelines.
• Do not capture skilled interventions accurately or inflating services such as undercoding or overcoding. 

How iSolve RCM Supports Accurate Wound Care CPT Coding

Wound care coding and billing requires precision, but iSolve RCM makes it quite easy and efficient with their experienced revenue cycle management team and expertise in wound care revenue management. Right from accurate coding of wound care CPT codes such as 97597, 97602, 97605, and 97606 to appropriate documentation and optimal reimbursement, iSolve RCM assists healthcare facilities in minimizing claim denial, overcoming audits, and increasing their cash flows, while still ensuring that wound care coding is in line with the latest rules and regulations of the payers.

FAQs

What is CPT code 97597?

CPT 97597 is a code which is relevant for selective debridement of devitalized tissue for an area measuring 20 sq cm or less.

What is the basis for making a choice between 97597 and 97602

The CPT procedure code for skilled selective debridement is 97597, whereas it is 97602 for nonselective or routine debridement.

What is CPT code 97597?

CPT 97597 is a code applicable for selective debridement of devitalized tissue for an area of 20 sq cm or less.

When to use CPT Code 97602?

CPT 97602 is a code used to pertain to nonselective debridement of necrotic and slough tissue.

How are 97605 and 97606 different from each other?

CPT 97605 is used for negative pressure wound therapy, ≤ 50 sq cm, while 97606 is used > 50 sq cm.

Can the wound dressing be billed separately?

A wound dressing procedure code will be considered billable only when it requires skilled and medically designated services, and not when it is performed on a routine patient.

How do I decide between 97597 and 97602?

Use CPT code 97597 for skilled selective debridement and code 97602 for nonselective or routine debridement.

How many times can 97605/97606 be billed

The NPWT codes are usually reimbursed on a per-session basis. The session rates are determined by the number of sessions the patient receives a week. The codes provided in

What is required to document on CPT 97597?

There should be documentation of the extent of the wound, tissue excised, instruments employed, and medical reasoning.

Is there any code size constraint in NPWT?

Yes, 97605 includes wounds ≤50 sq cm, and 97606 includes wounds >50 sq cm.

Are multiple codes for a wound allowed on the same claim date?

Yes, but each code has to represent a different injury or different services, according to the payer guidelines.