Guide to CPT Code 97597: Billing and Coding for Wound Debridement

Simplifying CPT Code 97597

Billing and Coding Tips for Wound Debridement

CPT Code 97597 is a critical code used to report wound debridement procedures performed on open wounds. This procedure is essential for removing nonviable or necrotic tissue from a wound to promote proper healing. CPT 97597 is specifically used for wounds that measure 20 square centimeters or less, and it includes various debridement methods, such as high-pressure water jet and sharp selective debridement with instruments like scissors, scalpels, and forceps.

The application of CPT 97597 is important for medical professionals and billing specialists as it plays a significant role in accurate coding and reimbursement for wound care procedures. This comprehensive guide covers everything you need to know about CPT 97597, including its definition, appropriate usage, documentation requirements, coding guidelines, and common billing challenges.

Understanding CPT Code 97597

CPT Code 97597 is categorized under active wound care management and is used to report the debridement of open wounds. This procedure includes the removal of devitalized tissue (e.g., necrotic epidermis, dermis, fibrin), exudate, debris, and biofilm to facilitate wound healing. Additionally, the code covers the use of topical applications and whirlpool therapy when performed, alongside wound assessment and instructions for ongoing care.

Important Considerations for CPT Code 97597

• Time-Based Coding: CPT 97597 is a time-based code, meaning it represents a single session of wound debridement, irrespective of how long the procedure takes. Proper documentation of service time in the patient's records is essential.
• Wound Size Limitation: This code applies to wounds with a surface area of 20 square centimeters or less. For larger wounds, CPT 97598 should be used for each additional 20 square centimeters. Therefore, accurate measurement of the wound is crucial.
• Debridement Methods: The code covers various methods of debridement, such as high-pressure water jet, sharp selective debridement, and other mechanical or surgical techniques.

When and How to Use CPT Code 97597

Appropriate Uses of CPT Code 97597

CPT 97597 is applicable for the debridement of open wounds that need removal of nonviable tissue to promote healing. These wounds could be traumatic, infected, or caused by conditions like ulcers or chronic wounds. The code can be used by physicians, nurse practitioners, and physical therapists working within the scope of their practice.

• Example: If a patient has an ulcer with fibrin and necrotic tissue present on the surface, a debridement procedure performed with a high-pressure water jet or sharp debridement tools would be billed under CPT 97597.

Limitations of CPT Code 97597

This code is used exclusively for wounds that are 20 square centimeters or less. If a wound exceeds this size, CPT 97598 is used for each additional 20 square centimeters. Therefore, accurate documentation of the wound’s surface area is critical to ensure the correct code is applied.

• Example: A wound measuring 25 square centimeters would require CPT 97597 for the first 20 square centimeters, and CPT 97598 for the remaining 5 square centimeters.

Documentation Requirements for CPT 97597

Accurate and thorough documentation is key to ensuring proper coding, billing, and reimbursement for services related to CPT 97597. When reporting this code, healthcare providers must document the following:

Wound Assessment:

• Size: Document the exact size of the wound (in square centimeters), ensuring it does not exceed 20 square centimeters.
• Location: Specify the exact location of the wound.
• Stage: Indicate the wound’s stage (e.g., stage 2 pressure ulcer).
• Complications: Note any comorbidities or complications associated with the wound, such as infection or ischemia.

Debridement Techniques:

• Detail the specific debridement technique used, whether it's sharp debridement with scissors, scalpel, or forceps, or mechanical methods such as high-pressure water jets.
• Describe the tissue removed, including terms like fibrin, necrotic epidermis, or biofilm.

Topical Applications:

• If any topical agents or dressings were applied after debridement, include the specifics (e.g., hydrocolloid dressing).

Wound Surface Area:

• Accurately measure the surface area of the wound to ensure it falls within the 20 square centimeter limit for CPT 97597.

Whirlpool and Ongoing Care:

• If whirlpool therapy is used, document its necessity for the treatment, and include any instructions for ongoing care provided to the patient.

Important Coding Guidelines for CPT 97597

• Time-Based vs. Procedure-Based: CPT 97597 is a time-based service, meaning that while the procedure is session-based, the documentation should specify the time spent on the procedure to support the billing.
• Bundling and Billing Restrictions: CPT 97597 should not be billed with CPT codes 11042-11047 for the same wound on the same day. If both debridement and dressing application are performed, CPT 97597 covers the dressing, and no additional charges for dressings can be made.
• Whirlpool Use: Whirlpool therapy is often bundled into CPT 97597. It should only be billed separately if it treats a different body part or if the documentation supports the therapy as a separate, identifiable service.

Common Billing Issues and Tips for CPT 97597

1. Accurate Wound Measurement: Ensure accurate wound size documentation to determine eligibility for CPT 97597. Always recheck wound measurements before coding.
2. Proper Modifier Use: If the procedure requires the use of whirlpool therapy, the appropriate modifier may be needed if it is billed separately.
3. Medical Necessity Documentation: Ensure that the medical necessity for the debridement procedure is thoroughly documented, particularly in cases involving chronic wounds or infected ulcers. This includes a clear rationale for why the debridement is required and how it supports healing.
4. Avoidance of Double Billing: Do not bill CPT 97597 with CPT 97602 or other bundled codes like CPT 29580 (Unna boot) unless explicitly justified by the documentation.

Common Mistakes with CPT Code 97597 and How to Unbundle Correctly

When using CPT Code 97597, medical billing professionals often make a few common mistakes related to bundling and unbundling. Here’s a brief guide to help you avoid these pitfalls:

Common Mistakes:

Billing Whirlpool Therapy Separately:

• Mistake: Whirlpool therapy (CPT 97022) is often billed separately, even though it’s typically included in CPT 97597 when performed during the debridement session.
• Solution: Do not bill for whirlpool therapy unless it’s provided for a different body part or there’s documentation to justify it as a separate service. When it's part of the debridement session, it is bundled into CPT 97597.

Reporting Dressings Separately:

• Mistake: Some providers mistakenly bill for dressings after debridement, thinking they are separate services.
• Solution: Dressings applied after debridement are included in CPT 97597. Do not report dressings separately unless they’re provided outside the debridement process.

Using Multiple Debridement Codes for the Same Wound:

• Mistake: Billing both CPT 97597 and CPT codes 11042-11047 for the same wound.
• Solution: CPT 97597 should not be used with 11042-11047 for the same wound. CPT 97597 covers selective debridement for superficial wounds, while 11042-11047 is for deeper tissue debridement. These codes should not be reported together for the same wound on the same date.

How to Properly Unbundle:

To avoid billing errors, follow these tips for correctly unbundling services when necessary:

• If whirlpool therapy is performed on a different body part, or as a distinct procedure, use modifier 59 to indicate that it's a separate service.
• If only a dressing change is performed, use the appropriate code for the dressing change, not CPT 97597.

Do not combine CPT 97597 with deeper tissue debridement codes like CPT 11042-11047. Ensure the depth of debridement is clearly documented to avoid confusion and ensure accurate billing.

FAQs About CPT Code 97597

Conclusion

Accurate coding and documentation of CPT 97597 are essential for proper reimbursement and compliance. At Stat Medical Consulting, Inc., our expert team helps practices reduce claim denials (as low as 1%) and secure fast reimbursements (within 2 days).

If you’re facing claim issues or struggling with reimbursements, consult us for a free medical billing review. We’ll identify errors, guide you on best practices, and ensure timely, full reimbursements—helping your practice stay profitable.