Answer: No, CPT 97597 and 97598 are reported for debridement of the epidermis and/or dermis. For ulcer debridement of the subcutaneous tissue you would report
11042 for the first 20 sq cm and CPT 11045 for each additional 20 sq cm
. Make certain documentation contains the sq cm of the debridement.
When do you use 97597?
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.
Is 11042 covered by Medicare?
Dressings applied to the wound are part of the service for CPT codes 11000-11012 and 11042-11047 and may not be billed separately.
Medicare does not separately reimburse for dressing changes or patient/
caregiver training in the care of the wound.
Does Medicare pay for 97597?
Medicare reimburses physicians according to the Medicare Physician Fee Schedule (MPFS), which is based on Relative Value Units (RVUs) and payment varies by geographical region.
Wound Care and Debridement are reported
with CPT® codes 97597, 97598 and 11042-11047.
What does CPT code 11042 mean?
11042 –
Debridement, subcutaneous tissue
(includes epidermis and dermis, if performed); first 20 sq cm or less. +11045 – each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
How do you bill for dressing changes?
When performed by a physician, dressing changes for burns and debridement of burn tissue should be reported using
codes 16020–16030
, depending on the size of the burn.
Does 97597 need a modifier?
One would bill CPT 97598 in 20 cm2 increments or portion thereof. These wounds can be anywhere on the body.
There are no bilateral T or F modifiers required
. Furthermore, if you only bill these two codes together, there is no need to append any modifiers such as a 59 modifier to CPT 97598 when billing with CPT 97597.
Can nurses bill for wound care?
A: The 99211 E/M visit is a nurse visit and should be used only by a medical assistant or a nurse when performing services such as wound checks, dressing changes or suture removal. CPT code 99211
should never be billed for
physician, physician assistant or nurse practitioner services.
Does CPT code 15271 include debridement?
CPT Codes:
The CPT procedure code series 15271-15278 should be used for the application of a skin substitute. The CPT code typically
includes all services provided including the office visit, debridement and supplies
, except the product, which is reimbursed separately.
Does Medicare pay CPT 97602?
97602 CPT Code Description
97602 CPT code is assigned a status of B under the Medicare Physician Fee Schedule (MPFS). When this service is provided by a discipline that receives reimbursement based on the MPFS, this code is
not separately reportable or payable
, meaning that it is not separately payable under Medicare.
Who can bill for 97602?
ANSWER: CPT code 97602 includes the wound(s) assessment. Therefore, when a
physician/non-physician practitioner
evaluates the patient in a provider-based wound care clinic, report the professional E/M code for the hands-on services of the physician/non-physician practitioner.
What does CPT code 97597 mean?
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.
Does 11043 need a modifier?
11043, debridement, muscle and/or fascia, first 20 sq. cm or less. 11042-XS, debridement, subcutaneous tissue, first 20 sq. cm
or less with modifier
to identify distinct procedural service on a separate site.
What modifier is needed for 11042?
Modifier -59 or -XU
is appended to indicate that the VAC it is a distinct service from code 11042. The documentation should clearly state that the wound VAC was medically necessary because the wound was left open.
Does CPT code 97597 have a global period?
The third major change is that all of the primary CPT debridement codes (97597, 11042, 11043, and 11044) now have a
0-day global period
. Previously, CPT codes 11043 and 11044 were assigned a 10-day global period by the Centers for Medicare and Medicaid Services.
What is the global period for CPT 11042?
The payment for 11043 is almost five times more than the payment for 11042 (debridement of skin and subcutaneous tissue only) when performed in a hospital or ambulatory surgery center and is based on 45 minutes of intraservice physician work and has a 10 day global period (payment for 11042 is based on 15 minutes of …
