Medical Billing Dilemma -Debridement Reimbursements

Lately debridement medical billing has brought up many questions in the healthcare industry. The medical billing CPT codes 97597-97598 can usually not be used by every provider. The American Medical Association recently released these new Current Procedural Terminology codes. Interpretation of these two medical billing codes varies from payer to payer.

When the American Medical Association first released the codes 97597-97598 there was a lot of confusion. Shortly after that release the Centers for Medicare and Medicaid Services offered an explanation of the medical billing codes. 97597 (Removal of devitalized tissue from wounds, selective, debridement, without anesthesia, with or without topical applications, wound assessment, and instruction for ongoing care, may include use of a whirlpool, per session; total wound surface area less than or equal to 20 square centimeters) and 97598 (…total wound surface area greater than 20 square centimeters) may be billed by providers that are not therapists, clinical nurse, Physicians, psychologists or nurse practitioners. As you can see these medical billing codes allow no therapists to submit, by Medicare guidelines.

Many payers did not interpret the Current Procedural Terminology codes in this manner. What does this mean for medical billing? Quite a lot regarding your medical billing reimbursements. It means that if you will use these medical billing codes on your claims, you may want to check the policy of each individual payer first. Some payers may have the same policy as the centers for Medicare and Medicaid Services and others may not.

Document medical necessity to the hilt and found out the policies for payment from the carrier you will be submitting your claims to and you will increase your chances of a reimbursement for this type of medical billing claim.

View all Articles by: Melissa Clark, CCS-P