Debridement Codes 97597-97598

FirstLadi

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East Orange, NJ
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Good Afternoon,

I have a physician who states that CPT codes 97597-97598 are not to be billed by physicians and the first debridement code should always be 11042. I tried to explain to the physician that the CPT codes 97597/97598 replaced debridement codes 11040 and 11041, but he insist that these codes are not billable by the physician only therapist.

Is there any information are or references that anyone can assist me with in helping this physician avoid an audit?
 
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It really has nothing to do with the type of provider, it's more situational:

"Code 97597 is a wound care management code that involves serious wounds requiring extensive debridement. For each additional 20 sq cm or part thereof of total wound surface area, report the add on code 97598, Debridement, e.g., high pressure waterjet with or without suction, sharp selective debridement with scissors, scalpel and forceps; open wound, e.g., fibrin, devitalized epidermis and or dermis, exudate, debris, biofilm; including topical application, wound assessment, use of a whirlpool, when performed and instructions for ongoing care, per session, total wound surface area; each additional 20 sq cm, or part thereof; list separately in addition to code for primary procedure."

"When choosing the correct code for a debridement procedure on the skin, such as those that an emergency department provider may perform, study the codes from 11000 to 11047, Debridement procedures on the skin."
 

espressoguy

Expert
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Tacoma, WA
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CPT 97597/98 is a "sometimes therapy" code. This means that this procedure can be performed by a physical therapist. This does not mean that it can only be done by a physical therapist.

My podiatrists do this minor procedure every day of the week. They do not necessarily do an 11042 as the first debridement. It is dependent upon the severity of the ulcer/wound.
 
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