CCI / Hot Coding Topics

CCI UPDATE 97597-97598: CCI Will Correct Debridement Glitch

Hang on to your claims for these wound care management codes.

As most veteran coders know, you can’t report an add-on code unless you report it along with its “parent code” on the same claim. But an NCCI glitch has made it impossible for you to collect for both the debridement add-on code 97598 and its partner code 97597 — creating denied claims and confusion for practices that perform active wound care management. However, a new announcement indicating that the NCCI is fixing the problem should ease your coding angst.

The American Podiatric Medical Association (APMA) issued a release on its Web site stating that the National Correct Coding Initiative (NCCI) edits currently bundle the following two codes together:

97597 — Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less
+97598 — …each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

This edit bundle has an indicator of “0,” meaning that no modifier can separate these codes. Fortunately, the APMA caught the error and contacted the NCCI director about it.

“The NCCI is currently working on a solution and recommends that APMA members delay submission of claims reporting combination of CPT 97597 and CPT 97598 until the NCCI replacement file is in place and implemented by CMS,” the APMA’s statement says. “The April 1, 2011 version of NCCI does not contain this edit error.”

The APMA has not yet gotten word on whether Medicare contractors will automatically reprocess claims that were paid in error...

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March 3, 2011
Hot Coding Topics

Clear The Smoke On Debridement And Active Wound Care Codes

Confused about when to choose a debridement code and an active wound code? CPT 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth.

“Depth is the only documentation item you need to determine the correct code,” explained Chad Rubin, MD, FACS, AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member with Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member at their joint presentation “General Surgery” at last month’s CPT Symposium in Chicago.

Active wound care, which has a 0 day global period, is for active wound care of the skin, dermis, or epidermis. For deeper wound care, use debridement codes in the appropriate location.

Example: Codes 11040 (Debridement; skin, partial thickness) and 11041 (…full thickness) have been deleted. The parenthetical note under the codes’ deletion reads, “For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598.” The codes are revised for 2011 to reflect this change. For instance, the revision for code 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) removes “Skin, and” and adds after subcutaneous tissue “includes epidermis and dermis, if performed.”

Code 97597 is revised to (Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq cm or less]).

Code 97597’s revision involves “mainly rewording to make clear how active wound care is separate from integumentary wound care,” Bothe explained.

CPT...

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December 15, 2010