Wiki Wound debridement..

[shecodes]

There has been instruction handed down to us stating that 97597 can ONLY be billed when water jet was used based on an interpretation of the CDR.

We were instructed that since our providers do not use water jet, that we are to code 11042 if it is subq, if not it would be an e&m.

I've downloaded and printed everything I could get my hands on for support that this is not true, but I'm wondering what other information, from reputable sources, everyone else might have.

I read the article in the October Business Monthly, but even that example uses water jet.

Or have I been doing this wrong all these years?

 

[espressoguy]

If you look at the full description for 97597, waterjet is only one of the tools available.

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 ]

The confusion may lie in the fact that the debridement codes changed on Jan 1, 2011. I didn't start working as a coder until Oct, 2011 (happy anniversary to me) but the guidelines for 97597 were different prior to 2011. There were 2 additional codes (11040,11041) that were discontinued when the 2011 changes were made.

 

[shecodes]

Unfortunately, the confusion isn't within the code description, but one individuals interpretation of the CDR.

A health care provider performs wound care management by using selective debridement techniques to remove devitalized or necrotic tissue from an open wound. Selective techniques are those in which the provider has complete control over which tissue is removed and which is left behind, and include high-pressure waterjet with or without suction and sharp debridement using scissors, a scalpel, or forceps. Wound assessment, topical applications, instructions regarding ongoing care of the wound, and the possible use of a whirlpool for treatment are included in these codes. Report 97597 for a total wound surface area less than or equal to 20 sq cm and 97598 for each additional 20 sq cm or part thereof.

The emphasis keeps being placed on the CDR. My interpretation of the CDR is that it is describing the different techniques that can be used, but instead I was told I'm incorrect and that the CDR is explaining that all of the techniques are to be utilized or the procedure cannot be billed. E.g. in the CPT description is being completely ignored.

 

[espressoguy]

All I can tell you is that you are correct and the other person is wrong. Their rationale makes no sense. If you use a waterjet, normally you wouldn't need to also use any additional tools. Similarly, if you use scissors, scalpel or any other sharp tool, you wouldn't need to use a waterjet.

I'm not sure if any of my providers even have access to a waterjet.

Would it be possible to bring your providers into the conversation?

 

[shecodes]

We have brought this to their attention and they agree that this direction is wrong.

Very frustrating situtation