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97602 - Pt came in for sebaceous

  1. Default 97602 - Pt came in for sebaceous
    Medical Coding Books
    Pt came in for sebaceous cyst and we charged 99213.25 and 10060. Pt then came back 3 days later where we removed the packing and repacked. We charged a 97602 but it was denied by the payer saying not separately reimbursable. Is there another code to use? Should we not have used 97602? Does anyone find that some payers pay and some don't for 97602?

  2. #2
    2 problems with this.

    1. There is a 10 day global period with 10060, you don't get to charge for changing dressings within this time frame.

    2. Changing a dressing is not debridement.

    This is not a billable service with any code based on what you have posted.

    Laura, CPC, CPMA, CEMC

  3. Default
    We actually didn't do just a dressing change. We removed the packing, irrigated (which debrides) and repacked. I can understand where just changing a dressing would be inclusive and we wouldn't charge but a lot of work went into this visit. We have 1 payer that won't pay this but the others do.

  4. #4
    Columbia, MO
    I think I will agree with Laura on this. You are charging for a wound care code using non-selective debridement techniques. Irrigation is not a non-selective debridement technique. Wet-to-dry dressings is as is chemicial and mechanical abrasions. A high pressure jet is a selective debridement technique. But an irrigation is just wound cleansing and cannot be confused with debridement. If you are using a high pressure jet then you have the wrong code, as for reimbursement, some carrier apply a 0 global to the 10060 which is why they would reimburse and others apply the 10 day global. If you are performing a selective or non-selective debridement technique be sure the provider has carefully documented all the necessary ingredients to support the usage of those codes.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Milwaukee WI
    Default Global
    First ... I'm with Laura and Debra on this one.

    Second ... if you packed the wound on the first procedure you should have coded 10061. Here's the lay description from Encoder Pro ...
    The physician makes a small incision through the skin overlying an abscess for incision and drainage (e.g., carbuncle, cyst, furuncle, paronychia, hidradenitis). The abscess or cyst is opened with a surgical instrument, allowing the contents to drain. The lesion may be curetted and irrigated. The physician leaves the surgical wound open to allow for continued drainage. For complicated or multiple cysts in 10061, the physician may place a Penrose latex drain or gauze strip packing to allow continued drainage. Complicated cysts may require later surgical closure. Report 10060 for incision and drainage of a simple or single abscess. (emphasis added by FTB)

    The increased RVUs (and reimbursement) for 10061 vs 10060 helps to cover the cost of the additional work that may be required during the postoperative period.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. Default
    If you are billing for the physician, the 97602 is not a covered code because physicians don't normally do the work themselves. You would just use an E&M code anyway.

  7. Default Wound Care with Packing
    Would 97602 be the appropriate code when a patient is seen post c-section for the following: wound cleansing, wet to dry dressing with packing. Pt is seen every 3 or so days for this for an infection disrupted c/s wound. She has been seen 7 times thus far and will be coming back until the wound is healed. Thanks in advance for help.

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