A report published by the American Academy of Home Care Medicine revealed that nearly 6.5 million people in the USA are affected by chronic wounds each year, and a vast majority of them are senior citizens aged 65 and above. Chronic wounds are caused by conditions like diabetes, pressure ulcers, and foot ulcers and require proper treatment and management.
Increased demand for wound care has expanded its market size to over $4.43 billion, and it is expected to grow at a CAGR of 6.8% until 2032. Therefore, wound care providers must capitalize on these gains and not miss revenue opportunities due to coding mistakes. We have prepared a list of the most used CPT codes for wound care in 2024. So, take a look and optimize your coding accuracy.
Most Common Wound Care CPT Codes in 2024
From wound dressings to wound debridements and hyperbaric oxygen therapy (HBOT) to compression therapy, a range of procedures and services are rendered for wound care.
The current procedural terminology (CPT) is a standardized system of medical code sets that covers the assessment, treatment, and management of different types of wounds, including burns, infection wounds, surgical wounds, diabetic ulcers, and more.
In this section, we will look at this year’s most frequently reported wound care CPT codes for evaluation and management (E/M) visits, active wound care management, surgical debridement, and skin substitution.
Wound Care CPT Codes for Evaluation and Management Visits
CPT Code Range 99202-99205 – Wound Care E/M Visits, New Patients
Providers must refer to this wound care CPT code range when they meet a new patient and assess his wounds to make decisions varying in complexity. For example, CPT code 99202 is reported when the provider meets a new patient in an office or outpatient setting for 15 or more minutes, evaluates his wound, and makes a straightforward decision on wound care and management.
On the other hand, CPT code 99205 is used when the provider meets the new patient for 60 or more minutes, and the visit involves high-level decision-making.
CPT Code Range 99212-99215 – Wound Care E/M Visits, Established Patients
Healthcare providers must refer to the CPT code range 99212-99215 for evaluation and management visits of returning or established patients. The provider can report wound care CPT codes 99212-99215 after E/M visits with a returning patient during which his chronic wound is assessed, and based on the analysis, the treatment is either continued, adjusted, or ceased.
These codes can also be used when an established or regular patient meets the provider for the first time for wound care but has had previous encounters with the same provider for separate conditions and procedures. For example, an E/M visit of a regular patient for trauma wound care. Again, the codes are time-specific and assigned based on the complexity of decision-making.
CPT Codes for Active Wound Care Management
Active wound care is the process of removing dead tissue from the wound to expedite healing and prevent scarring. It involves debridement, applying topical treatments, and dressing the wound.
Providers can report wound care CPT codes if the procedures were performed in a hospital setting, an outpatient wound care clinic, or during home health visits. The most used CPT codes for active wound care management are as follows.
CPT Code 97597 – Debridement (E.g., High-Pressure Waterjet With/Without Suction)
A wound care specialist, nurse, or any other qualified healthcare professional is required to report this CPT code when treating an open wound with a surface area of 20 square centimeters (sq cm/ cm2) or less.
97597 wound care CPT code indicates that the provider excised dead tissue from an open wound using scissors, forceps, or a scalpel and washed the wound with a high-pressure water jet with or without suction. The procedure may also involve applying topical medication, wound assessment, use of whirlpool, and imparting instructions for effective home care.
CPT Code 97598 – Debridement, Each Additional 20 cm2
97598 is an add-on wound care CPT code and is used after 97597 if an additional 20 cm2 of the wound’s surface area requires debridement.
Again, the provider may use scissors, a scalpel, or forceps to excise dead tissue, blood clots, and other debris from the open wound, use a high-pressure water jet with or without suction for deep removal and cleaning, and apply topical medications to prevent infections. He may also perform wound assessment, use a whirlpool, and instruct the patient on how to care for the wound.
CPT Code 97602 – Removal of Devitalized Tissue from Wound(s)
While wound care CPT codes 97597 and 97598 represent ‘selective debridement’, CPT code 97602 represents ‘non-selective debridement’ of viable or non-viable tissues from an open wound.
The provider reports this code when he removes devitalized (dead) tissue from the wound(s) without using anesthesia. He also assesses the depth of the wound, applies topical medication, and instructs the patient on ongoing care. 97602 is assigned for one such debridement session.
CPT Code 97605 – Negative Pressure Wound Therapy with DME
CPT code 97605 for wound care is used when the provider performs negative pressure wound therapy (NPWT) on the wound(s) measuring 50 cm2 or less in surface area. He uses durable medical equipment (DME) to apply controlled subatmospheric pressure on the wound, creating a vacuum for drainage collection.
This technique removes fluid and infectious material from the wound and seals the area to promote healing. The provider assesses the wound, applies topical medication, and informs the patient on how to take care of the wound.
CPT Code 97607 – Negative Pressure Wound Therapy with Disposable Equipment
The primary difference between wound care CPT codes 97605 and 97607 is the type of equipment used to apply controlled subatmospheric pressure on the wound. While DME is used during 97605, the provider uses disposable or non-durable medical equipment during procedure 97607.
Again, NPWT is performed on a wound measuring 50 cm2 or less to create a vacuum and drain fluids and infectious material from the site. The pressure also seals the wound and promotes healing in the case of decubitus ulcers or pressure sores. During the session, the provider may also assess the wound, apply topical treatments, and instruct the patient on ongoing care.
CPT Code 97610 – Low Frequency, Non-Contact, Non-Thermal Ultrasound
Wound care CPT code 97610 denotes a procedure (MIST therapy) for wound healing rather than debridement. The provider uses low-frequency ultrasonic energy to continuously deliver mechanical vibrations to the wound bed and heal it. The procedure may also involve topical applications, wound assessment, and instructing the patient on ongoing care.
Please note that Medicare does not allow providers to separately report 97610 if another active wound care procedure was performed on the same day on the same wound.
Wound Care CPT Codes for Surgical Debridement
Surgical debridement is the process of removing nonviable (dead) tissue, bacteria, or other foreign material from a wound using surgical instruments like scalpels, scissors, and forceps. Timely removal of dead cells and tissues from the wound site/bed prevents bacterial infection and promotes healing.
Of all the services and procedures performed by wound care specialists, surgical debridement is the most critical one. Hence, appropriate use of wound care CPT codes becomes necessary to capture accurate reimbursements from insurance payers.
Following are some of the most frequently reported wound care CPT codes for surgical debridement.
CPT Code 11000 – Debridement of Extensive Eczematous or Infected Skin
A wound care provider uses CPT code 11000 for the surgical debridement of dead tissues and cells that make up 10% of the body’s total surface area. Sterilized surgical instruments are used to excise a large portion of eczematous or infected skin.
CPT Code 11001 – Debridement of Extensive Eczematous, Each Additional 10%
Wound care CPT code 11001 is used in addition to 11000. It denotes that the provider excised or surgically removed another 10% of dead skin from the wound after debriding the first 10% (code 11000) in the same session.
CPT Code 11004 – Debridement of Skin, Subcutaneous Tissue, Muscle, and Fascia
While CPT codes 11000 and 11001 report debridement on unspecified wound sites, code 11004 is particularly used for debridement of dead skin, tissues, fascia, and muscles from the genitalia and perineum.
The provider assigns this CPT code for wound care after he has surgically debrided/ excised devitalized yet soft skin, tissue, or connective tissue from the external genitals (male or female) and the tiny patch of skin below the pelvic diaphragm (perineum).
CPT Code 11006 – Debridement of Skin, Subcutaneous Tissue, Muscle, and Fascia, With/Without Fascial Closure
The surgical removal of dead skin, tissues, connective tissues (fascia), and muscles from the external genitalia, perineum, and abdominal wall is billed through the wound care CPT code 11006. The provider may or may not perform fascial closure (surgically closing the inner layers of the abdomen after incision) during the procedure.
CPT Code 11008 – Removal of Prosthetic Material or Mesh, Abdominal Wall
CPT code 11008 describes the surgical removal of mesh or prosthetic materials from the abdominal wall. This is an add-on procedure and is performed to treat an infection. Code 11008 is separately reported from a primary debridement, incision, or drainage procedure.
CPT Code 11010 – Debridement Including Removal of Foreign Material
The provider uses wound care CPT code 11010 when surgical debridement is performed at the site of an open fracture or dislocation. He uses sharp instruments like scissors, forceps, and scalpels to excise necrotic (dead) tissues and foreign material from the skin in and around the open fracture.
Please note that this code can be reported in conjunction with treatment for a fracture unless mentioned otherwise.
CPT Code 11042 – Debridement, Subcutaneous Tissue, First 20 cm2 or Less
Wound care CPT code 11042 is also for site-specific surgical debridement. The provider uses this code when he surgically removes dead tissue in the skin and all the way down to the subcutaneous layer, covering up to 20 cm2 or less of the epidermis and dermis.
CPT Code 11043 – Debridement, Muscle and/or Fascia, First 20 cm2 or Less
Similarly, code 11043 is reported when the provider surgically debrides the dead skin and tissues in the muscle or fascia. It also covers an area of 20 cm2 or less, including the epidermis, dermis, and subcutaneous tissue.
CPT Code 11044 – Debridement, Bone, First 20 cm2 or Less
11044 is a CPT code for wound care that denotes the surgical removal of devitalized or infected tissue from the bone. The provider uses sharp instruments like scissors, scalpels, and forceps to cut the debris from a wound as big as 20 cm2 (or less), targeting the infected epidermis, dermis, and subcutaneous tissue.
CPT Code 11045 – Debridement, Subcutaneous Tissue, Each Additional 20 cm2
Wound care CPT code 11045 is an add-on code. It should be used when a provider surgically removes dead tissue from the skin’s subcutaneous layer (including the epidermis and dermis). The provider performs the excision on an additional 20 cm2 of the wound site after treating the initial 20 cm2 of the infected area (code 11044).
CPT Code 11046 – Debridement, Muscle and/or Fascia, Each Additional 20 cm2
Like the code above, 11046 is also reported separately as an add-on code after a primary procedure has been performed.
If the provider finds it necessary to surgically debride an additional 20 cm2 of the devitalized tissue from the muscle and fascia (including the skin’s epidermal, dermal, and subcutaneous layer) to prevent infections and promote healing, he proceeds with the excision and bills it using 11046 CPT code for wound care. This procedure can be performed in the same session as the initial debridement.
CPT Code 11047 – Debridement, Bone, Each Additional 20 cm2
Wound care CPT code 11047 is another add-on procedural code that denotes the surgical removal of dead, infected, or damaged bone tissue from an open wound. The provider uses a surgical knife, scissors, or forceps to excise the skin’s epidermal, dermal, and subcutaneous layers and muscle or fascia (if needed) around a bone to disinfect the wound and stimulate healing.
However, this procedure is performed after the initial debridement and if another 20 cm2 of the wound requires surgical excision.
Wound Care CPT Codes for Skin Substitute
Around 1.96% of the U.S. population is affected by chronic non-healing wounds that develop as a result of diabetes, ulcers, infections, poor blood circulation, and improper lifestyle (smoking, obesity, stress, etc.). Skin grafting or skin substitute is one of the best treatment methods for chronic non-healing wounds, burns, or traumatic injuries.
A wound care specialist or surgeon uses bioengineered (synthetic) or patient’s natural skin to cover open wounds and stimulate tissue regeneration for natural healing. Hence, the following wound care CPT codes for skin substitutes cover area-specific skin grafting procedures on children and adults alike.
CPT Code 15271 – Skin Substitute Graft Trunk/Arm/Leg
Code 15271 is specifically used for skin substitute procedures on the trunk, arms, or legs to cover a wound up to 100 cm2 in size. However, this code must be reported when a provider uses a skin graft, like an allograft or xenograft, to cover the first 25 cm2 of the wound.
CPT Code 15274 – Skin Substitute Graft Trunk/Arm/Leg – Additional 100 cm2
Wound care CPT code 15274 denotes area and age-specific skin substitute procedure. First, you must understand that this code is only to be reported if the skin grafting occurs on the trunk, arms, or legs. Second, if the patient is 10 years or older, the provider will use a skin graft, such as an allograft or xenograft, to cover up to 100 cm2 of the wound.
However, if the patient is an infant or a child under 10, the provider will only cover 1% of the body with the skin substitute. Moreover, this is an add-on procedural code and addresses an additional 100 cm2 of skin grafting (for patients aged 10 and above) after an initial 100 cm2 of skin substitution.
CPT Code 15278 – Skin Substitute Graft Face/Neck/Hands/Feet/Genitalia
Wound care CPT code 15278 also covers an add-on skin substitute procedure. However, this time, the procedure is performed on the face, scalp, neck, ears, hands, feet, or genitalia. The provider uses bioengineered skin grafts, such as a xenograft or allograft, to cover an additional 100 cm2 of the wound in patients aged 10 and above, or 1% of the body if the patient is below 10 years of age.
The code can be reported if the add-on skin substitute service was performed in the same session as a primary skin grafting.
Bottom Line
If you really want to seal the deal with an insurance payer for rendering wound care services to their beneficiaries, then just knowing the most frequently reported CPT codes for wound care is not enough. You must assign them to the highest level of specificity and ensure that they support the patient’s ICD-10 diagnosis to prove their medical necessity.
Moreover, wound care modifiers like LT, RT, 25, and 59 must be used where necessary to help the payer understand the details of the procedure. However, if you still think that wound care CPT coding is nightmarish and the main reason for your claim denials, then partner up with MediBill MD for end-to-end wound care billing services. It includes accurate CPT coding for as low as 1% of your net collections (for the first month of service).
