97597 and 97598

sjmccarl52

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With the new rules this year for 97597 and 97598, I am having trouble getting multiple 97598's paid. Medicare says they are duplicates. I tried using units and Medicare didn't like that. Sooooo, I did a line for every 97598 and added mod 59. When our A/R person called Medicare, she asked if 51 mod would work. The answer was no. Since I am billing for the Wound Healing Center at our hospital, I have this alot. Any ideas?
 

armen

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These codes are based on surface area. 97598 is add on code for 97597 for each additional 20 sq cm. So in order to bill 97597 + 97598 your total wound(s) surface area should be at least 40 sq cm.
 

sjmccarl52

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The surface area was 107 sq cm. I needed to bill the 97597 and 97598 for EACH 20 sq cm. That would be 4 units of 97598. Medicare is calling them duplicates.
 

armen

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The surface area was 107 sq cm. I needed to bill the 97597 and 97598 for EACH 20 sq cm. That would be 4 units of 97598. Medicare is calling them duplicates.
I have never billed for that many units, but I looks like the denial is wrong. I would appeal.
 

ERA965

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hi,
i have the same problem. in my case, the wounds are located at different sites (abdomen, lower extremity, middle leg & distal leg). My question is are these add on wounds billed as multiple units of 97598 or each seperate line item of 97598. Please let me know. thanks in advance
 
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97598

Has anyone had any success in getting multiple units of 97598 paid with 97597? I have several that have denied. :confused:
 

pdege

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Researching this issue we have found that the AMA updated the description for codes 97598 and 97597 in 2011, but Medicare did not follow suite. This may be why you are getting denials because Medicare recognizes the pre-2011 CPT description for these codes.
 

squeaker7

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I have successfully billed 97597 + 97598 with 3 units. Medicare paid on all. I didn't use any modifiers, just billed the 97598 with the 3 units. Haven't had to go up to 4 or more units yet. :)
 

espressoguy

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Researching this issue we have found that the AMA updated the description for codes 97598 and 97597 in 2011, but Medicare did not follow suite. This may be why you are getting denials because Medicare recognizes the pre-2011 CPT description for these codes.
As best as I can recall, Medicare caught the error in March of last year and is now recognizing the 2011 changes.

I don't believe we have had any problems getting multiple units of 97598 paid by Medicare. I have been coding for the wound clinic at my hospital for the past 4 months.
 
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Nat

Has anyone heard that Medicare only allows a Max of 4 units per day for 97598 add-on? Or is it 1 unit 97597 and the add-on 97598 with 3 units to total the 4 units?
 

espressoguy

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I believe it is a total of 4 units (97597 + 97598). Regardless, as long as the documentation supports it, greater than 4 units will be paid on appeal.
 

cward267

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97597 billed with 97598

I have billed and been paid by Medicare -
97597 -
97598 - (4 units)
97598 76 (4 units)
and have billed as many as 8 lines
 

mjstack

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Multple unit billing for 97598 2017

trying to establish base line of MUE for 97598. My wound care center can care for up to 1916 sq cm of damage which means 97597 x1 unit & 97598 x 95 units. It is not going thru the EMR scrub. What can I do to assure payment?
 

CodingKing

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trying to establish base line of MUE for 97598. My wound care center can care for up to 1916 sq cm of damage which means 97597 x1 unit & 97598 x 95 units. It is not going thru the EMR scrub. What can I do to assure payment?

You can't assure payment without likely going through an appeals process w/ notes after MUE denial by payer.
 
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