Forum - Questions & Answers

Jun 1st, 2011 - marymurk 2 

wound care clinic billing

we will be starting a physician based outpatient wound care clinic and would like to know about some of the billing issues-can the physician bill out for 97597?

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Jun 3rd, 2011 - daystarjj 4 

re: wound care clinic billing

Yes, physicians can bill for 97597. I bill for podiatrists and family practice- this is an acceptable service they perform.

Hope this helps!


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Jun 3rd, 2011 - jschmutz   323 

re: wound care clinic billing

Per CPT: 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.

A health care provider performs wound care management by using selective debridement techniques to remove devitalized or necrotic tissue from an open wound. Selective techniques are those in which the provider has complete control over which tissue is removed and which is left behind, and include high-pressure waterjet with or without suction and sharp debridement using scissors, a scalpel, or forceps. 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 each additional 20 sq cm or part thereof.

Issue: January 2009

Title: Physical Occupational Therapy / PTs, OTs and other NPPs are the focus of wound care codes

*PTs, OTs and other NPPs are the focus of wound care codes*

Think "surgery" and "anesthesia" when trying to decide when to use active wound care management codes 97597-97602 instead of the long-standing debridement codes 11040-11044. The active wound care management codes were added to CPT® back in 2001 to replace HCPCS code G0169 (removal of devitalized tissue, without anesthesia). Distinguish between them this way: Use codes 11040-11044 for surgical wound debridement performed usually by physicians. These codes often coincide with anesthesia.

In contrast, use codes 97597-97602 for non-surgical debridement performed by non-physician healthcare providers such as physical therapists (PTs) or occupational therapists (OTs). Nurse practitioners and physician assistants may also use these codes. These codes are intended to report an entire treatment session, not the number of individual wounds or areas treated during the session.

Don't use the wound care management codes in addition to debridement codes 11040-11044 during the same encounter, but it's OK to use other 97000 series codes along with 97597-97602.

The primary goals of a physical or occupational therapist who's managing a wound are to debride any devitalized tissue, cleanse the wound, promote wound coverage and restore tissue function. Documentation to support use of these codes should include: wound evaluation; a thorough history - including development of the wound; current complaints; an exam that notes wound location, size, drainage, color/texture changes, temperature, vascularity; and a treatment plan.

You might use codes 97597-97598, for example, when a PT or OT uses a serial instrumentation method of debridement using forceps or scissors to remove loosely attached necrotic tissue. You'd expect to have this performed over the course of several short visits, and for the patient to experience little bleeding or pain.

However, a sharp debridement method using scalpels or scissors may also be coded with 97597-97598. This method has the PT or OT cutting along a line of demarcation between healthy and necrotic tissue. It's more likely to cause the patient some bleeding or pain, but it's done infrequently and for a very short period of time. Although sharp debridement is within the scope of most PTs, check with your state just to be sure.

Code 97602 describes a less-specific method that's usually performed on alternate days, sometimes with sharp debridement. Tools used often include whirlpool, wet-to-dry or wet-to-moist dressings (which assist in mechanical debridement) and enzyme applications. Patients clearly suffer minimal bleeding or pain with these treatments.

Don't try to use active wound care management codes to report simple dressing changes for a wound. These codes are intended to report selective and non-selective debridement or negative pressure wound therapy done to promote wound healing, although they do happen to include necessary dressing application and/or removal. The dressings used to protect the wound are not coded separately.

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