In a recent program memorandum, transmittal A-02-129, the Centers for Medicare & Medicaid Services (CMS), published information regarding billing for active wound care procedures. Active wound care management is reported with CPT codes:
- 97601—Removal of devitalized tissue from wound(s); selective debridement, without anesthesia (e.g. high pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session
- 97602—Removal of devitalized tissue from wound(s); non-selective debridement, without anesthesia (e.g. wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session
CPT code 97601 is a physical therapy service and is paid under the Medicare Physician Fee Schedule. The payment for CPT code 97602 is recognized under the OPPS as a packaged service, i.e., the service is not separately paid under OPPS. However, the cost of the service is packaged into whatever other service is provided on that date.
If a service coded under code 97602 is performed at the time of a clinic or emergency visit, the evaluation and management (E/M) service must be documented in accordance with the hospital’s documentation guidelines for clinic and emergency visits.
The hospital may bill outpatient visit code 99211, Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician, when the only service provided is 97602. Payment for 97602 will be packaged into the payment for 99211.