When wound care services are provided, hospitals should bill these services using the CPT codes listed below. When such services are performed either by a qualified therapist or a physician or a nonphysician practitioner under an approved therapy plan of care, providers must attach an appropriate therapy modifier (i.e, GP for physical therapy, GO for occupational therapy, and GN for speech-language pathology). When provided by a qualified therapist, the therapy revenue code also needs to be reported (i.e., 0420, 0430, or 0440).
When these services are not provided by a qualified therapist, physician, or a nonphysician practitioner under an approved therapy plan of care (i.e., as an incident-to-service), providers should bill the CPT code that describes the service furnished without a therapy modifier.
The outpatient code editor (OCE) logic will either assign these services to the appropriate APC for payment under the OPPS if the services are non-therapy, or will direct contractors to the MPFS established payment rates if the services are identified on hospital claims with a therapy modifier and/or therapy revenue code as therapy.
Here is a list of reclassified CPT codes for wound care services:
|CPT code||Descriptor||CY 2005 Therapy designation||CY 2006 Therapy designation|
|97597||Selective debridement (less than or equal to 20 sq. cm.||“Sometimes therapy”||“Sometimes therapy”|
|97598||Selective debridement (greater than 20 sq. cm.)||“Sometimes therapy”||“Sometimes therapy”|
|97602||Non-selective debridement||“Always therapy”||“Sometimes therapy”|
|97605||Negative pressure wound therapy (less than or equal to 50 sq. cm.)||“Always therapy”||“Sometimes therapy”|
|97606||Negative pressure wound therapy (greater than 50 sq. cm.)||“Always therapy”||“Sometimes therapy”|