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97597 attempted and Medicare issues

  1. #1
    Lafayette Indiana
    Default 97597 attempted and Medicare issues
    Medical Coding Books
    I need help in determining a CPT code for the following scenaro: This is Medicare - doctor attempted debridement sharply with 15 blade but the patient experienced pain. Therefore used a moistened saline sponge to remove mild slough from the wound site and stimulate some bleeding. Physician wants to charge 97597, however according to CPT Assistant 97597 is appropriately used only for the types of debridement identified in the code descriptor. A sponge is not listed as a type of debridement in the code descriptors. So 97597, 52 or something else? Also wondered if anyone is having trouble with the debridement "add on" codes 97598, 11045, 11047 for number of units?
    Ruth, CPC
    Ruth, CPC, CPMA

  2. #2
    You might look at 97605 for non-selective debridement... but looking at the code description it still may not work.

    We have also been having tons of trouble getting our debridement codes paid. There was an issue with the MUEs for the first quarter that had only one unit of 97598 listed as medically likely. After 04/01/11 we refiled all our claims for this code to Cahaba (we are in Tennessee) and we can get paid for one unit of 97598 but the others deny duplicate. Also we had to bill each add on code as an additional line item with one unite per line or we wouldnt even get paid for the one unit!!
    At this point the only other option I believe we have is writing re-determination letters for each one of these which is going to be a pain but that's pretty much my last resort since calling Cahaba customer service is an absolute waste of time!
    I will say that I have noticed some of the commercial payors have paid on some of the excisional debridement codes with multiple units all billed on one line item.
    Mary Beth Gord, CPC

  3. #3
    Lafayette Indiana
    Thanks Mary Beth, I was aware of MUE issue and we have come to same conclusion with Medicare and rebilling the incorrectly denied debridement codes. I have even contacted provider education for clarification on the MUE's - no response. These debridement codes have been a pain from the beginning.
    Ruth, CPC
    Ruth, CPC, CPMA

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