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Active Wound Care Codes

  1. #1
    Smile Active Wound Care Codes
    Medical Coding Books
    I have a question about debridement codes. We have used the codes 11040 & 11041 which Medicare denied after the 1st billing. We found out we were to use the codes 97597 thru 97606, active wound care management. Does anyone know if you need to use active wound care codes for all insurance companies? This is brand new coding for us. Thanks for your help.

  2. #2
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    Quote Originally Posted by Jtk625 View Post
    I have a question about debridement codes. We have used the codes 11040 & 11041 which Medicare denied after the 1st billing. We found out we were to use the codes 97597 thru 97606, active wound care management. Does anyone know if you need to use active wound care codes for all insurance companies? This is brand new coding for us. Thanks for your help.
    who do you bill for? Podiatrist?

  3. Default Wound Care Codes
    I will be interested in the feed back on this question. Its my understanding that 11040-44 codes are skin debridements - based on depth of debridement and the physician uses a scalpel.
    In 97597-97606 these codes are for wound care management - ongoing care and assessment. The technique is also different and code also depends on size. Hope this helps a little.

  4. #4
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    surgery practice

  5. #5
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    The 11040-44 debridement codes are surgical codes for the removal of necrotic tissue, taking also bleeding healthy tissue, doc must state depth, e.g. partial, full thickness, muscle, tendon, and or bone. He must document the removal of such tissue plus go beyond the original margin of the wound to healthy viable tissue. Anesthetic, instruments used and description of wound after debridement must also be documented. The wound should be larger after surgical debridement.

    Active wound care codes are billed when only necrotic tissue is removed, staying within the margin of the wound, these are billed once per session, in the case of multiple wounds add all measurements together and bill either 97597 for 20 sq cm or less 97598 for over 20 sq cm. The wound measurement should remain the same.

  6. #6
    Smile active wound codes
    Thank You Cheri!!

  7. Default
    We use the 3m encoder, and I find that if I try to do a surgical debridement of skin alone, I get the 97597 with the ICD-9 of 8622. Conversely, if I try to do non-excisional debridement of SQ tissue, I get 11042 with ICD of 8628. This ends up reading non-excisional CPT with excisional ICD, and surgical/excisional with a non-excisional ICD. If anyone else uses a different encoder, I'd be interested to know what CPTs/ICDs show up for surgical debridement of skin and also non-excisional debridement of SQ. It's almost seeming like depth is the only criteria. Does surgical debridement have to be done with a scalpel? Our MDs rarely use scalpels for theirs. Also, I'd like to know if anyone knows a site that tells you the ICD-9s for the various skin substitutes out there. Per Nosology, I've been using 8665 for the Oasis (not the dressing, but the surgically fixed skin sub), and 8667 for most of the others.

  8. #8
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    Quote Originally Posted by lkledonne View Post
    We use the 3m encoder, and I find that if I try to do a surgical debridement of skin alone, I get the 97597 with the ICD-9 of 8622. Conversely, if I try to do non-excisional debridement of SQ tissue, I get 11042 with ICD of 8628. This ends up reading non-excisional CPT with excisional ICD, and surgical/excisional with a non-excisional ICD. If anyone else uses a different encoder, I'd be interested to know what CPTs/ICDs show up for surgical debridement of skin and also non-excisional debridement of SQ. It's almost seeming like depth is the only criteria. Does surgical debridement have to be done with a scalpel? Our MDs rarely use scalpels for theirs. Also, I'd like to know if anyone knows a site that tells you the ICD-9s for the various skin substitutes out there. Per Nosology, I've been using 8665 for the Oasis (not the dressing, but the surgically fixed skin sub), and 8667 for most of the others.
    You bumped an almost 3 year old thread.

    The debridement codes changed in 2011. CPT 11040 & 11041 were eliminated.

    Now the only criteria for wound debridement is size & depth. Skin, 97597/97598. Subcutaneous 11042/11045. Muscle and/or fascia, 11043/11046. Bone, 11044/11047.

    The first code in the set is for up to 20 sq. cm. The second code is for each additional 20 sq. cm.

    If there are multiple wounds, you add up the total size of wounds of the same depth and code accordingly.
    L. Mark Kozu, COC, CPC, CCC

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