97597 and 97598-Does anyone

[bgardner0125]

Does anyone know how many per day units MCR will pay for when the add on code 97598 is used? Or does anyone know where I can find out? Thanks

 

[BUDDY1983]

97598

97598 is an add on code for each additional sq. cm. or part thereof.

So for all wounds debrided for the epidermis level you would add them together LXW subtract 20 that represents the first unit (97597) then divide by 20 and that is the # of units you would bill for 97598.

Ex. 12X7= 72
72-20=52
52/20=2.6

you would bill 97597 x1 unit and 97598 X3 units.

If they are not paying I would appeal making sure notes supports first.

 

[ddrbiller]

I am trying to understand the breakdown on how to determine the units. Can you go a little deeper?

 

[bgardner0125]

Suppose we have a patient with 395.6cm2. do I dare bill MCR for 18 - 19 units? Everything looks documented but a lot to be billing. I don't want to cause an audit either.

 

[bgardner0125]

Just incase anyone is wondering. We received payment for 5 units from MCR. I just don't know about about doing 18 or 19 units yet. I'm not real comfortable with that. Does anyone have any ideas?

 

[Torilinne]

97598 has a work RVU of only .24 so billing 18-19 units of this really isn't "over-coding" as long as your documentation supports that measurement. The claim should show it billed as x18 or x19 units and not listed on 18 or 19 individual lines. There is a global of 0 days for 97597 and so billing this service once per day, along with the 97598 add-on code is needed, is allowable.

Torilinne
SCC, CPC, CGIC