Part B Insider (Multispecialty) Coding Alert

Published on Thu Jan 06, 2005 PDF

You can make up to $250 extra per claim by using the existing codes

When CPT 2005 included two new debridement codes, coders were excited but also confused. How did 97597 and 97598 mesh with existing debridement codes 11040-11044? And which should you use for your doctor's claims?

Although 97597-97598 allow you to code based on the diameter of the wound debrided, those new codes are only intended for non-physicians, according to physician Bruce Rappoport with RCH Healthcare Advisors in Fort Lauderdale, FL. Some carriers, including First Coast Service Options, have issued policies stating that 97597-97598 are only for physical therapists, occupational therapists or enterostomal nurses.

New codes pay less: If you do bill 97597-97598 for physician claims, you probably won't receive a denial, but you'll lose money, Rappoport warns.

First Coast reimburses a paltry $50 for 97597. The non-facility payment for 11040 is $42.59, but physicians are more likely to bill 11041 (which pays $62.62 non-facility) or 11042 (which pays $87.71 non-facility). And 11044, the highest-paying debridement code, has a non-facility reimbursement of $310.00 in Florida, Rappoport notes.

There are two other crucial differences between the 11040 series of debridement codes and 97597-97598, says Christine Lufkin, surgery coding specialist with Medical College of Wisconsin. The descriptors for 97597-97598 specify that the patient isn't under anesthesia during the debridement. And 97597-97598 includes a high-pressure waterjet or suction device.

Some coders have suggested they could use 97597 for bedside dressing changes because the descriptor specifies that the patient doesn't receive anesthetic. But you should never use a debridement code for anything other than actual wound care, Rappoport insists. "Performance of a dressing  change only is not separately reported and is included in the evaluation and management service," Rappoport adds.

Supervision required: The 97000 series of debridement codes only came into existence two years ago, Rappoport notes. Although only non-physicians should bill for these codes, they require those providers' direct supervision. The physical therapists and other non-physician providers can't delegate the debridement to other providers, Rappoport says.