The wound care (97597-97598) and debridement codes (11042-11047) are used for debridement of wounds that are intended to heal by secondary intention. Some conditions that support medical necessity include infections, chronic venous ulcers, and diabetic ulcers, to name a few.
Many insurance carriers, including Medicare, have medical policies regarding wound care. It is important that there be a documented plan of care with documented treatment goals. Medical necessity must be supported in the documentation for performing wound care services.
This documentation must include, at a minimum: Current wound volume (surface dimension and depth) Presence (and extent) or absence of obvious signs of infection.
CPT codes 97607 and 97608 are used for services provided using disposable devices such as mechanically powered devices. Unlike electronically powered devices, mechanically powered devices are not considered DME because of their disposable nature. Documentation for Wound Care.
This code is based on a wound size (after cleansing, prepping, and/or debriding) maximum of 100 sq cm. Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 0 to 25 sq cm (first 25 sq cm within the maximum wound size grouping up to 100 sq cm). If the leg/ankle wound area is greater than 25 sq cm, but less than the maximum of group size up to 100 sq cm, then bill CPT 15271 plus
The surgical preparation codes, CPT 15002-15005, “are to be used for the initial traumatic wound preparation (removal of appreciable nonviable tissue) and cleaning to provide a viable wound surface (primary intention healing) for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy.”