March 2010

APCAnswer Letter Page 7

Wound care

Several factors determine code anesthesia (e.g., high pressure waterjet with/
A patient with multiple wounds at different sites without suction, sharp selective debridement
receives active wound management at one wound with scissors, scalpel, and forceps), with or with-
site, but receives different treatment for the other out topical application(s), wound assessment, and
wounds. May we bill an active wound management instruction(s) for ongoing care, may include use
code and an E/M level for the other area or areas? of a whirlpool, per session; total wound(s) sur-
face area greater than 20 square centimeters
The answer depends on what the physician ordered,
what was performed, and what is documented for These codes are mutually exclusive with a CCI
each wound. indicator of 0, which means you may never re-
Most FIs/MACs have Local Coverage Determina- port the codes together during the same session
tions (LCD) that specify what providers must doc- or visit.
ument to support the service that was rendered. CMS has said reporting an E/M code is inappropri-
Documentation requirements are very specific con- ate when a CPT code describes the service provided.
cerning the type of tissue present, the type of tis- (Refer to the Federal Register, November 24, 2006,
sue removed/treated, and the requirements for each for the Final Rule for calendar year 2007 OPPS.)
method of treatment. NCCI edits also dictate code For example, dont report an E/M level for nonse-
pairs that may be reported for the same date of ser- lective debridement because 97602 describes the
viceeven if multiple wound sites are present. For service. n
example, if a clinician performed a nonselective de-
bridement on one wound and active management on You have questions we have answers
another wound, you may report only an active man-
Some coding questions are devilishly perplexing, but
agement CPT code:
dont despair. Let our panel of coding experts come to
97597Removal of devitalized tissue from
the rescue.
wound(s), selective debridement, without an-
APC Answer Letter is here to help you with those
esthesia (e.g., high pressure waterjet with/with-
coding dilemmas that can stymie and frustrate even the
out suction, sharp selective debridement with most experienced coding specialist. Chances are youre
scissors, scalpel, and forceps), with or without not alonesomewhere in this vast coding universe, at
topical application(s), wound assessment, and least one other coder is probably struggling with the
instruction(s) for ongoing care, may include use same question.
of a whirlpool, per session; total wound(s) surface So remember that help is only a mouse click away.
area less than or equal to 20 square centimeters Send an e-mail with your questions to gspanek@hcpro.com.

97598Removal of devitalized tissue from Our panel of experts looks forward to hearing from you.

wound(s), selective debridement, without

Answer 5: d. Answer 4: b. Answer 3: c. Answer 2: a. Answer 1: a.

(from p. 8) Quick coding quiz answers

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