Many family doctors give wound care to nursing home patients. Proper coding and billing for such wound care are critical to ensuring adequate payment and avoiding potential claims of fraud or abuse. Determining when to describe chemical cauterization of granulation tissue vs debridement is one of the issues in this area, particularly for Medicare patients.
The wound care (97597-97598) and debridement codes (11042-11047) are used for wound closure with a secondary aim. Infections, persistent venous ulcers, and diabetic ulcers are a few examples of situations that indicate the medical need. Wound care patients frequently have underlying health issues that require concurrent treatment, training, other services, and coordinated care. On the same day as a debridement service, an evaluation and management (E/M) service should not be charged unless it is a “separately identifiable service” different from the debridement service. If the practitioner is also addressing other conditions besides wound care, the practitioner may report an E/M service with Modifier 25 attached to the E/M service.
Codes for Active Wound Care Management
Active wound care methods eliminate dead or dying tissue and improve healing. Direct (one-on-one) patient interaction is expected of the practitioner. These procedures have a global period of 0 seconds. These codes cover topical treatments, evacuation, whirlpool wound examination, and ongoing care recommendations. Wet-to-dry dressings, use of drugs containing enzymes to break down damaged tissue, whirlpool baths, minor excision of loose pieces with scissors, peeling tissues with sharp objects, exfoliation with pulse lavage, high-pressure drainage, and incision are all CPT codes.
Wound Debridement Codes
CPT codes (11042-11047) document wound debridement codes. The depth of tissue removed and the surface area of the wound is recorded for wound debridement. These services can be performed for injuries, infections, wounds, and chronic ulcers. When debridement on a single wound, report depth using the deepest level of tissue removed. Sum the surface area of wounds at the same depth in many wounds but do not combine sums from various depths. These operations necessitate forceps, scissors, a scalpel, or tissue nippers. The codes are used when the wound is meant to heal by secondary intention.
- If the bone is debrided from a 4-cm2 heel ulcer and a 10-cm2 ischial ulcer, the work should be reported with a single code, 11044.
- When debriding subcutaneous tissue from a 16-cm2 dehisced abdominal wound and a 10-cm2 thigh wound, use 11042 for the first 20 cm2 and 11045 for the second 6 cm2.
- Use modifier 59 with 11042 or 11044 if all four wounds were debrided on the same day.
- A persistent venous stasis ulcer, pressure sore, or traumatic open wound that will not heal shortly is frequently the diagnosis. Check that the ICD-10-CM code assigned is accurate and that the documentation validates the diagnosis code chosen.
Codes for Wound Vacuum-Assisted Closure
When just negative-pressure wound therapy is performed, CPT codes 97605 and 97606 are utilized (e.g., placement of a wound vacuum on an open wound). These operations may also be documented after the wound has been debrided or excised but has not been closed. The wound vacuum is utilized as a dressing, do not record these codes (e.g., the wound is closed, and a wound vacuum is placed). These CPT codes now need durable medical equipment (DME) (e.g., reusable equipment) typically powered by electricity.
CPT codes 97607 and 97608 are assigned to services performed with disposable devices, such as mechanically powered devices. Mechanically powered devices, as opposed to electronically powered devices, are not regarded as DME due to their disposable aspect.
Wound Care Documentation
Make certain that the documentation contains a legible process note. Keep track of the equipment used (curette, scalpel, and additional instruments) and the regularity of surgical debridement. Record the total devitalized tissue (wound surface) assessment before and after surgical debridement. Record the area and depth of devitalized tissue taken from the wound (not just the depth of the wound). Blood loss and a description of the tissue removed should be documented, as should evidence of the wound’s reaction to therapy. This documentation must include the following:
- Wound loudness at the moment (surface dimension and depth).
- The presence (or absence) of apparent indications of infection.
- The presence (and extent) of necrotic, devitalized, or completely unviable tissue.
- The material in the wound that is likely to undermine healing or encourage the destruction of neighboring tissue.
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