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Wound Care Best Practice For The Medical Coding Process

Wound care involves every stage of wound management. This includes diagnosing wound type, considering factors that affect wound healing, and the proper treatments for wound management.

Successful wound management starts with a thorough assessment of the wound and periwound skin. The anatomic location of the wound, the degree of tissue damage, the type of tissue in the wound and surrounding it, and the wound size in itself are assessed by the physician in determining the type of wound and deciding the treatment options available for the patient. Other factors that affect active wound care management and the medical coding process are the underlying medical conditions of the patients.

Active wound care is performed to remove devitalized and/or necrotic tissue and promote healing and requires face-to-face management between the physician and the patient.

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.

Let us look into some specific Medical coding CPT codes for Debridement.

CPT 97597 and/or CPT +97598 are reported for recurrent open wound debridement when medically reasonable and necessary. These codes are used when debridement is performed with high-pressure waterjet with/without suction or for sharp selective debridement with scissors, scalpel, and forceps.

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. These codes 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.

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 whirlpool, CPT 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 also not separately payable.

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.

CPT 11042-11047 are based on the tissue debrided.

11042, +11045  – subcutaneous tissue

11043, +11046 – muscle and/or fascia

11044, +11047 – bone (includes epidermis, dermis subcutaneous tissue, muscle and/or fascia, if performed)

These codes should not be reported for 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.

CPT 11042 -11047 are reported when performed before the application of a topical or local anesthesia.

CPT 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.

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).

Performing deep debridement in a Place of Services other than inpatient hospital, outpatient hospital or ASC and Billing of debridement by unqualified personnel are the most common reasons for denials to look out for while coding for debridements.

The Medical Coding process for Wound care requires experienced coders who can understand these nuances and ensure 100% accuracy. Quintessence has over 10 years of experience in the Wound care Medical coding process and can help get the maximum collection for your practice. Our Machine learning tool Codessence is a state-of-the-art automated coding platform that has eased the Medical coding process by requiring minimal audit and supervision. Get the best for your practice’s Medical coding process with Quintessence as your RCM partner.


L34587_GSURG051_BCG.pdf (cms.gov)

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