Wound Care Coding
SCCM Critical Connections – December 2018
by Deborah Grider
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.
Wound care patients often have underlying medical conditions that require concomitant management and may also require education, other services, and coordination of care. An evaluation and management (E/M) service on the same day as a debridement service should not be billed unless it is a “separately identifiable service” distinct from the debridement service. If the provider is managing wound care in addition to other conditions, the provider may report an E/M service with Modifier 25 appended to the E/M service. If the sole purpose of the visit is wound care management, only the wound care codes should be reported. A separate procedure note should be documented in the medical record.