Confusion of 97597/loss of 11040/11041

Jody Mortensen

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I'm confused on using 97597/97598 for debridement of skin in-place of 11040/11041. If a podiatrist documents debridement of a full-thickness ulcer or partial thickness ulcer, the CPT instructions direct you to use codes 97597/97598. My confusion is with using 97597 for a Medicare patient. The CPT code falls under Medicare's wound care policy & in reading it the 707.1x codes don't meet medical necessity. Does anyone have any advice on how Medicare will handle this, I'm assuming denial due to diagnosis code not covered, or advice on what I can do, the facility I work for can do for coverage. Thank you in advance for your time & advice.

Jody Hecht
 

banderson77

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Depending on your area, your best bet would be to look at the Medicare LCD for your area. I have never used 97597 for any of my debridementsbecause it says without scalpel which is what my doctor always uses. Hope this helps.
 

tanyaharberts

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Alexandria Minnesota Chapter
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I read it to understand a scalpel IS an appropriate tool:
97597: "Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less"
 

ebarnett

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97597

I've had no problems getting this paid with the 707.1x codes. As long as the debridement does not go down to the subcutaneous tissues this is the code you would use. If it does go that far down then you would use 11042 etc

Elaine Barnett,CPC
Jefferson City, MO
 

MMAYCOCK

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Wound care chart

I'm confused on using 97597/97598 for debridement of skin in-place of 11040/11041. If a podiatrist documents debridement of a full-thickness ulcer or partial thickness ulcer, the CPT instructions direct you to use codes 97597/97598. My confusion is with using 97597 for a Medicare patient. The CPT code falls under Medicare's wound care policy & in reading it the 707.1x codes don't meet medical necessity. Does anyone have any advice on how Medicare will handle this, I'm assuming denial due to diagnosis code not covered, or advice on what I can do, the facility I work for can do for coverage. Thank you in advance for your time & advice.

Jody Hecht
Here is what I think is an amazing chart for determining the correct code:
http://www.psnextra.org/Documents/Columns/CPT/CPTChartJan11.pdf
 
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