Debridement procedures keep many billers on their toes. Healthcare providers process millions of wound care claims every year, and guess what? Hundreds of thousands of these claims get denied by insurance payers. The main reason for these denials is misconceptions about the billing codes and human errors while filing the claim.
CPT code 97602 is a particularly tricky non-selective debridement code. Reason? Complex documentation and bundling guidelines. But you don’t have to worry. To help you file 97602 claims successfully, our expert billers at MediBillMD have compiled this detailed guide on CPT code 97602.
So, let’s start.
CPT Code 97602 – Description
The official definition of CPT code 97602 explains it as:
“Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.”
Although the definition is quite straightforward and self-explanatory, let’s break it down into simpler words.
97602 represents a procedure in wound care that involves various non-selective debridement techniques to remove both viable and non-viable tissue from wounds. It is different from simple debridement because it does not discriminate between healthy and dead tissue during removal.
CPT code 97602 has another name, “Sometimes Therapy” code. This is because physicians or non-physician practitioners (NPPs) can bill this code without a therapy plan of care. However, when non-selective wound debridement services are rendered under a physician’s/NPPs treatment plan, they should be billed without a therapy modifier.
Additionally, 97602 is not limited to a specific method. Many debridement methods can be used depending on the wound. The methods include the following:
- Wet-to-moist dressings that mechanically remove tissue upon removal
- Enzymatic debridement using collagenase or other enzymatic agents
- Mechanical debridement through gentle abrasion or whirlpool therapy
- Irrigation and cleansing that removes loose debris and slough
One important thing to note about CPT code 97602 is that the entire procedure is a collection of numerous sub-procedures that cannot be billed separately. These include:
- Wound assessment before and after treatment
- Application of topical medications or dressings
- Patient and caregiver instructions for ongoing wound care
- Documentation of wound characteristics and treatment response
Anesthesia is not included in this list. So, if sedation is required, you must bill it separately using the appropriate anesthesia code.
Scenarios Where CPT Code 97602 is Applicable
Let’s now discuss some scenarios in which CPT code 97602 can be used.
Chronic Wound Management
Treatment of diabetic foot ulcers is frequently billed with 97602. These wounds often
contain mixed tissue types, including necrotic tissue, slough, and granulation tissue. So, selective debridement does not make much sense in this scenario. The best approach is to use non-selective debridement.
In the case of diabetic foot ulcers, healthcare providers employ enzymatic debridement or wet-to-moist dressings to gradually remove devitalized tissue. Which, as we discussed above, is billed using CPT code 97602.
Pressure Ulcer Treatment
Physicians often treat Stage II and Stage III pressure ulcers with non-selective debridement. In these wounds, necrotic tissue mixes with viable tissue. Many billers get confused because of this, because logically, it would make more sense to use selective tissue removal.
However, while selective debridement might seem more appropriate, non-selective methods prove beneficial when wounds contain adherent slough that resists precise removal or when patient comfort requires gentler approaches. Before filing the claim, always confirm with the physician which debridement methods he used.
Applicable Modifiers for CPT Code 97602
You may append the following modifiers to CPT code 97602 to enhance coding specificity and collect accurate reimbursements.
| Modifier Category | Modifier Code | Description | Application Requirements |
|---|---|---|---|
| Anatomical Modifiers | LT | Left side procedures | When treating wounds on the left side of the body |
| RT | Right side procedures | When treating wounds on the right side of the body | |
| F1-F9, FA | Specific finger designations | For finger wound treatments | |
| T1-T9, TA | Specific toe designations | For toe wound treatments | |
| Procedural Modifier | 59 | Distinct Procedural Service | Multiple separate debridement sessions on the same day |
CPT Code 97602 – Billing & Reimbursement Guidelines
Paying attention to the following factors while creating and submitting claims for CPT code 97602 will help you collect fair and timely reimbursements for your services.
Medicare Status Indicator
CPT 97602 carries a Status Indicator “B” (bundled) in the Medicare Physician Fee Schedule Database. This means that separate payment is not allowed for physician services, as the cost is bundled into payment for other related procedures or services. However, therapists acting within their scope of practice must add appropriate therapy modifiers to receive reimbursement.
Documentation
Appending the appropriate documents with your claim is essential. Documents justify the medical necessity of the procedure, which then leads to claims acceptance. No documents or incomplete documentation means a denial. For CPT code 97602, the following documentation is required:
- Detailed wound assessment with measurements (length, width, depth)
- Photographic documentation when policies permit
- Description of tissue types present (necrotic, slough, granulation)
- Specific debridement technique employed (enzymatic, mechanical, irrigation)
- Amount and type of tissue removed
- Patient response to treatment
- Plans for ongoing wound management
Common Mistakes
The following common errors and mistakes often lead to 97602 denials:
- Insufficient documentation of medical necessity
- Incorrect modifier application or omission
- Failure to establish an appropriate therapy plan of care
- Inadequate documentation of wound measurement
- Missing justification for treatment frequency
Wrapping Up
Finally, our guide comes to an end. In this blog, we tried to simplify CPT code 97602 billing as much as possible. Over 6.5 million Americans experience chronic wounds annually. So, denied claims for wound care can significantly disrupt the revenue growth of healthcare providers. Therefore, extra care is essential while filing the claims.
If you are facing frequent claim denials or looking for a helping hand for your billing operations, consider wound care billing services from professionals at MediBillMD. The complete suite includes everything, from insurance verification to CPT coding, and denial management to payment posting.
