Complete Guide for CPT Code 97598 Wound Care Billing

Wound care billing confuses even experienced coders. CPT code 97598 sits at the center of this complexity. Understanding how to use this code correctly protects your practice’s revenue and prevents claim denials. This guide explains everything you need to know about CPT 97598 in clear, practical terms.

What CPT Code 97598 Actually Means

CPT code 97598 covers selective debridement of open wounds for each additional 20 square centimeters beyond the initial area. This is an add-on code. You cannot bill 97598 by itself. It must always be reported with CPT code 97597 on the same claim.

The procedure involves removing devitalized, necrotic, or infected tissue from a wound. Healthcare providers use various techniques, including high-pressure water jets, sharp selective debridement with scissors or scalpels, and mechanical methods. The goal is to remove dead tissue while preserving healthy tissue to promote wound healing.

This code applies to wounds measuring more than 20 square centimeters. For the first 20 square centimeters, you use CPT 97597. For each additional 20 square centimeters or any portion of it, you add one unit of CPT 97598.

Understanding the Add-On Code Structure

The relationship between 97597 and 97598 is critical. CPT 97597 is the primary code. It covers the first 20 square centimeters of selective debridement. CPT 97598 is the add-on code. It covers each additional 20 square centimeters or part thereof.

Here’s how it works in practice. A wound measuring 25 square centimeters requires CPT 97597 for the first 20 square centimeters and CPT 97598 for the remaining 5 square centimeters. A wound measuring 70 square centimeters requires CPT 97597 for the first 20 square centimeters plus three units of CPT 97598 for the remaining 50 square centimeters.

The phrase “or part thereof” is important. Even one additional square centimeter beyond 20 requires billing another unit of 97598. You don’t round down. A 41 square centimeter wound gets billed as 97597 plus two units of 97598, not one.

Calculating Wound Size Correctly

Accurate wound measurement determines correct coding. Measure the length and width of the wound in centimeters. Multiply length by width to get the surface area in square centimeters. Use consistent measurement points for each visit.

For multiple wounds treated during the same session, calculate the total combined surface area. If you debride three separate wounds measuring 10, 15, and 8 square centimeters, the total is 33 square centimeters. You bill CPT 97597 for the first 20 square centimeters and CPT 97598 for the remaining 13 square centimeters.

Use a ruler or calibrated wound measurement device. Document these measurements in your notes. Take measurements before debridement, not after. The pre-debridement size determines your code selection. Post-debridement measurements are important for tracking healing but don’t determine billing codes.

Who Can Bill CPT 97598?

Physicians, nurse practitioners, physician assistants, and physical therapists can bill CPT 97598 when working within their scope of practice and licensure. Medicare considers these codes “sometimes therapy” codes. This means they can be therapy services or medical services, depending on who provides them.

Physical therapists must have a physician-certified plan of care when billing to Medicare. The plan should document the medical necessity for wound debridement. Some states require physician supervision for physical therapists performing debridement. Check your state licensure requirements.

Qualified hospital staff can provide these services incident to a physician’s services. The staff must work under proper supervision according to Medicare guidelines. The supervising physician must see the patient periodically and certify the ongoing need for wound care.

Documentation Requirements That Support Your Claim

Your documentation must prove medical necessity and support your code selection. Every element matters when auditors review your claims.

Start with a thorough wound assessment. Document the wound location precisely. Note the wound type, whether it’s a pressure ulcer, diabetic ulcer, venous stasis ulcer, surgical wound, traumatic wound, or burn. Record the wound stage if applicable.

Measure and document the wound dimensions. Include length, width, and depth in centimeters. Calculate and clearly state the total surface area. If treating multiple wounds, list each wound separately with individual measurements, then provide the combined total.

Describe the tissue you removed. Document the type of devitalized tissue present, such as slough, eschar, fibrin, necrotic epidermis, necrotic dermis, exudate, debris, or biofilm. Note how much tissue you removed and from which areas of the wound.

Specify your debridement method. State whether you used high-pressure water jet, sharp selective debridement with scissors, scalpel with forceps, or mechanical debridement. Include details about maintaining sterile technique.

Document the wound appearance before and after debridement. Note characteristics like color, drainage, odor, temperature of surrounding tissue, and condition of wound edges. These observations support medical necessity.

Include any topical applications applied during the procedure. List medications, ointments, or dressings used. Document your patient education, including instructions for ongoing home wound care and follow-up scheduling.

Common Billing Errors and How to Avoid Them

Billing 97598 without 97597 is the most common error. This results in automatic claim denial. The system recognizes 97598 as an add-on code only. You must have the primary code 97597 on the same claim for the same date of service.

Overestimating wound size to justify more units is another problem. Auditors look for this. Use consistent, accurate measurements every time. Exaggerating wound size for higher reimbursement is fraud. The documentation must match reality.

Measuring each wound separately when you should combine them creates confusion. If you debride multiple wounds in one session, add all the wound areas together to calculate your codes. Don’t bill each wound as a separate encounter unless they truly are separate sessions.

Forgetting the “or part thereof” rule leads to underbilling. Many coders mistakenly believe that only full 20 square centimeter increments count. Remember that even one additional square centimeter requires another unit of 97598.

Billing for simple dressing changes as debridement causes denials. CPT 97598 requires the actual removal of devitalized tissue. Changing a dressing without removing tissue is not debridement. These are bundled services, not separately billable.

Inadequate documentation undermines valid claims. Writing “wound debrided” without measurements, tissue description, or method used invites denial. Auditors need specific details that justify the code and prove medical necessity.

When CPT 97598 Cannot Be Used

You cannot bill 97598 for post-operative wound care during the global period of a related surgery. The global surgical package includes routine post-operative wound care. You can only bill separately if the wound care is unrelated to the surgery or if complications require treatment beyond normal post-operative care.

Don’t use 97598 for non-selective debridement. Non-selective debridement uses methods like wet-to-dry dressings or enzymatic applications, where you don’t distinguish between viable and non-viable tissue. Use CPT 97602 for non-selective debridement instead.

You cannot bill 97598 with surgical debridement codes 11042 through 11047 for the same wound on the same date. These codes are mutually exclusive. The depth of debridement determines which code set to use. If you debride into subcutaneous tissue, muscle, or bone, use the surgical debridement codes, not 97597 or 97598.

Whirlpool therapy is included in 97598 when performed during the same session. Don’t bill whirlpool separately unless it’s for a different wound or body part treated during a distinct session. Use modifier 59 only when accurate documentation clearly supports separate, identifiable services.

Understanding Medicare Reimbursement

Medicare reimbursement for CPT 97598 varies by geographic location and setting. The 2025 national average for facility settings ranges from approximately 24 to 31 dollars per unit. For non-facility settings, reimbursement ranges from approximately 37 to 48 dollars per unit.

Your specific reimbursement depends on your Medicare Administrative Contractor region and the Geographic Practice Cost Index for your area. These adjustments account for regional differences in practice costs.

Commercial insurance typically pays 110 to 200 percent of Medicare rates. Reimbursement varies significantly based on whether you’re in-network or out-of-network and your specific contract negotiations with each payer.

Medicare has identified wound care as high-risk for improper payments. Expect increased scrutiny through Recovery Audit Contractor reviews and other audits. Complete, specific documentation protects you during these reviews.

Modifiers That May Apply

Modifier 59 indicates a distinct procedural service. Use this when you perform debridement on multiple separate wounds during the same session. The documentation must clearly show that each wound was treated separately and distinctly.

Modifier LT indicates the left side, and modifier RT indicates the right side. Use these when treating bilateral wounds to specify which side received treatment. This clarity prevents confusion and processing errors.

Modifier 76 indicates a repeat procedure by the same physician. Use this if you need to perform additional debridement on the same wound during a different session on the same day. This situation is rare but occasionally necessary.

Modifier 25 may be needed if you bill an evaluation and management service on the same day as the wound care. The E/M service must be significant and separately identifiable from the wound care procedure. Your documentation must clearly show both services and why both were necessary.

Linking Diagnosis Codes

Proper diagnosis coding supports medical necessity. Common ICD-10 codes for wounds requiring debridement include pressure ulcer codes in the L89 series, diabetic ulcer codes including E11.621 for type 2 diabetes with foot ulcer, and venous insufficiency ulcer codes in the I87 series.

Surgical wound complication codes include T81.3 for disruption of the wound and T81.4 for infection following a procedure. Traumatic wound codes vary by location and nature of injury. Burns use codes from the T20 through T32 series depending on location and degree.

The diagnosis code must match the wound being treated. Link each diagnosis to the appropriate procedure code. The documentation should explain why the wound requires debridement and how debridement promotes healing.

How Often Can You Bill CPT 97598?

Medicare typically allows billing once per 30-day period per wound. More frequent debridement may be covered with strong documentation of medical necessity. The documentation must explain why more frequent wound care treatment is needed.

Chronic wounds may require ongoing debridement over extended periods. Each visit requires fresh documentation showing current wound status, why continued debridement is necessary, and evidence of healing progress or complications preventing healing.

If the wound isn’t healing as expected, document why. Note factors affecting healing such as poor circulation, infection, patient non-compliance with care instructions, or underlying conditions interfering with recovery. This documentation supports continued treatment authorization.

Billing Multiple Wounds in One Session

Calculate the total combined surface area of all wounds debrided during one session. Use this total to determine how many units of each code to bill. Add up all the individual wound measurements before calculating your codes.

For example, if you debride three wounds measuring 15, 12, and 18 square centimeters, the total is 45 square centimeters. Bill CPT 97597 for the first 20 square centimeters and CPT 97598 twice for the remaining 25 square centimeters.

Document each wound separately in your notes. List location, size, appearance, and tissue removed for each wound. Then clearly state the combined total used for billing. This transparency helps if questions arise during the clean claim submission review.

Documentation Template Example

Good documentation looks like this. “Patient presents with diabetic foot ulcer, right lateral foot. Wound measures 6.5 cm in length by 5.2 cm in width, with a total surface area of 33.8 square centimeters. Wound shows yellow slough covering approximately 60 percent of the wound bed with purulent drainage. Sharp selective debridement was performed using sterile scissors and forceps, removing approximately 8 square centimeters of necrotic tissue and slough from the wound surface. Wound bed now shows healthy granulation tissue. Applied silver alginate dressing. The patient was instructed on daily dressing changes and signs of infection. Follow-up scheduled in one week.”

This note clearly states wound size, type of tissue removed, debridement method, and post-procedure status. The measurement supports billing 97597 plus one unit of 97598 for a total of 33.8 square centimeters.

Special Considerations for Different Wound Types

Diabetic ulcers often require extensive debridement because they develop significant necrotic tissue. These wounds frequently exceed 20 square centimeters. Document the patient’s diabetes status and any neuropathy or vascular compromise affecting healing.

Pressure ulcers require documentation of the stage. Stage 3 and Stage 4 pressure ulcers commonly need debridement. Note the anatomical location and any undermining or tunneling present. Document pressure relief measures in place.

Venous stasis ulcers typically occur on the lower legs. Document signs of venous insufficiency such as edema, skin changes, and poor circulation. Note compression therapy is being used alongside debridement.

Surgical wounds that dehisce or develop infection need clear documentation separating post-operative wound care from treatment of complications. Explain why the wound requires debridement beyond normal healing.

Burns require documentation of burn depth and total body surface area affected. Specify whether partial thickness or full thickness. Note any signs of infection requiring debridement.

Appealing Denied Claims

When claims get denied, review the denial reason code. Common denials include bundling issues, missing primary code 97597, insufficient documentation, or lack of medical necessity.

For bundling denials, verify that 97597 appears on the same claim. Check that you didn’t bill services that are included in the debridement code separately.

For documentation denials, submit additional records showing wound measurements, tissue type removed, debridement method, and medical necessity. Include photos if available and permitted by the payer.

For medical necessity denials, explain why debridement was needed. Describe how it helps healing and what complications may arise without it. Include clinical guidelines that support debridement for the specific wound type.

Conclusion

Accurate coding of CPT 97598 requires understanding its add-on nature, calculating wound size correctly, and documenting thoroughly. This code cannot stand alone. It depends entirely on having CPT 97597 as the primary code.

Take time to measure wounds accurately. Document every detail of the procedure. Explain why debridement was necessary. Follow the rules for calculating units based on total surface area.

Your documentation determines whether claims get paid. Auditors review wound care claims carefully. Give them clear, specific information that proves medical necessity and supports your code selection.

When done correctly, billing CPT 97598 ensures appropriate reimbursement for extensive wound debridement services. Your practice gets paid fairly, and your documentation proves the value of the care you provided to your patients.