ED Coding and Reimbursement Alert

Question: Our ED group also operates a wound care clinic. I have a procedure note that states, -Removed devitalized tissue from large wound, with topical application.- There are two codes to choose from for active wound care. Which code should I use for this procedure?


Connecticut Subscriber


Answer: Ideally, you-ll speak to the ED physician who treated the patient for some more information. If you don't get the wound size exactly right, your claim could be headed for denial.

Why? The codes for active wound treatment are based on the area of the patient's wound. If the wound surface area is less than or equal to 20 centimeters, you should report 97597 (Removal of devitalized tissue from wound[s], selective debridement, without anesthesia [e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], with or without topical application[s], wound assessment, and instruction[s] for ongoing care, may include use of a whirlpool, per session; total wound[s] surface area less than or equal to 20 square centimeters) for the procedure.

On the other hand, if the wound area exceeds 20 centimeters, you should report 97598 (... total wound[s] surface area greater than 20 square centimeters) for the procedure.

Best bet: Get the physician to note the exact wound size in the medical record each time he performs active wound care.