CPT Code 97597 Description: For Active Wound Care Management

Medical coding is a complex procedure because each code has specific requirements that must be met to ensure accurate reimbursements from relevant insurance companies. Hundreds of codes are available for different procedures under various specialty groups. You must review each code description carefully to ensure accurate reporting of the performed service or procedure. Tricky, isn’t it?

Thus, we dedicate this guide to discussing the coding and documentation requirements of the 97597 CPT code – listed in the active wound care management range. So, without further ado, let’s dive into the details!

Table Of Contents

CPT Code 97597 – Description
Things to Consider while Assigning CPT Code 97597
Documentation Guidelines for Reporting 97597 CPT Code
Bottom Line

CPT Code 97597 – Description

CPT code 97597 is maintained by the American Medical Association (AMA) under the code range for active wound care management.

You can bill it for wound assessment, open wound (such as biofilm, exudate, debris, devitalized epidermis or dermis, fibrin), debridement (such as sharp selective debridement with scissors, a high-pressure water jet without suction or with suction, forceps, and a scalpel), whirlpool, topical application and providing instructions for ongoing wound care per session.

Besides, the wound surface area for reporting CPT code 97597 must not exceed 20 cm²(square centimeters).

Things to Consider while Assigning CPT Code 97597

The following are the main considerations for billing the CPT code 97597:

Wound Size

While billing the 97597 CPT code, there is a wound size limitation. That is, you can only report this code for wounds with a surface area of 20 cm². For instance, if the surface area exceeds this limit, you must use code 97598 for every additional 20 cm².

Time-based Coding

97597 CPT code is time-based. That is, you can bill it for a single wound debridement session. However, it does not specify the time spent on the procedure. Therefore, you should document the procedure time in patient records to ensure information completeness.

Accurate Documentation

Another coding best practice for reporting this code is ensuring detailed and accurate documentation. It may include attaching additional information, test results, and physician notes justifying the procedure’s medical necessity and purpose.

Procedure Specificity

The billing requirements emphasize procedure specificity. Thus, even though the CPT code 97597 covers different debridement methods, you must document the specific tools and techniques utilized to perform the procedure. Additional information will help the insurance payer understand the specifications of the performed procedure and tally it with the code description to authorize its correct usage during claim processing.

Medical Necessity

Medical necessity is another criterion for ensuring accurate reporting of the 97597 code. Thus, strive to document all the debridement rationales, including signs of infection in the wound, non-viable tissue, or the presence of necrosis. Besides, you should include the potential benefits of the procedure in expediting wound healing.

Documentation Guidelines for Reporting 97597 CPT Code

Documentation is as important in medical billing as selecting the accurate code. Therefore, in this section, we will discuss the documentation guidelines for billing the CPT code 97597:

Wound Assessment

Your documentation must include adequate information related to the wound assessment. It may involve reporting the wound stage, location, and size, along with any comorbidities or complexities.

Topical Application

If the treatment requires you to apply any dressing or topical agents after performing the debridement, you should also report its specifics while billing the 97597 CPT code.

Debridement Technique

Another guideline to improve your chances of timely and accurate reimbursement against code 97597 is specifying the debridement technique. It can be a single method, such as sharp selective debridement, a high-pressure water jet, or a combination of techniques. You should also document the debridement extent, such as the removed tissue type, i.e., biofilm, epidermis/dermis, fibrin or debris, etc.

Wound Surface Area

The wound size is a significant criterion for billing this CPT code. Thus, we recommend you measure and report the surface area of the wound to ensure document accuracy and completeness.

Whirlpool Use and Ongoing Care

Did the procedure require you to use a whirlpool? If yes, document it as well. Besides, include any details related to the instructions that were given for ongoing wound care.

Bottom Line

The 97597 CPT code is assigned for active wound care management. It indicates the excision of dead tissue from an active wound not more than 20 cm²big and the application of topical medications to expedite healing.

While using this code, you must be mindful of the wound’s surface area, duration of the procedure, medical necessity, specificity, and documentation accuracy.

For timely reimbursement against this code, you should provide documentation for wound assessment, topical application, debridement technique, and whirlpool use.

We hope this guide will help you report this code effectively for reimbursement of an active wound care procedure. However, if you find it challenging, outsource wound care billing services to MediBill MD.

Frequently Asked Questions

What is CPT Code 97597?

It is a procedural code under the active wound care management range for billing of debridement from an open wound with a surface area of 20 cm² or less.

Is CPT code 97597 covered by Medicare?

No, Medicare does not reimburse for any wound care, debridement, and wound care training CPT codes, including 97597.

Is 97597 a physical therapy code?

No, it is not a physical therapy code. It is a CPT code under active wound care management.

Can you bill 97597 and 29581 together?

You cannot bill CPT code 97597 with 29581 for the same anatomic area.

Can you bill 97597 and 17250 together?

CPT code 17250 is excluded from consolidated billing. You can only report it separately. Contrarily, code 97597 is subject to SNF consolidation billing. You cannot bill these codes together. Besides, you should not report 17250 to avoid consolidated billing.

What is the difference between CPT code 97597 and 11042?

CPT code 11042 is from the code range for the debridement procedures on the skin. You can report it when the healthcare provider removes dead skin tissue in the skin using surgical instruments down to the subcutaneous layer, dermis, and epidermis.
Contrarily, you can bill CPT code 97597 when a physician devitalizes dead tissue from an open wound using different techniques. It is from the active wound care management code range. The procedure may involve providing instructions on wound care, wound assessment, application of topical medicine, and whirlpool.

What is the difference between CPT code 97597 and 97598?

Both 97597 and 97598 are from the same code range, i.e., active wound care management. You may report code 97597 when the surface area of the wound is 20 square centimeters (cm²) or less. However, if the wound size exceeds it, you should report the CPT code 97598 for each additional 20 cm².

Ultimate Guide to CPT Code 97597

CPT Code 97597 – Description