If you’ve ever stared at a wound care claim, wondering which code to use, or worse, had one denied because you picked the wrong one, you’re in the right place. Wound care CPT codes confuse even experienced coders with surface area calculations and depth-based rules, which results in coding errors. With the probability of errors this high, it’s essential to learn how to properly use CPT codes for wound care billing. This blog exactly explains that.
We aim to provide information on CPT codes, including selective debridement (CPT code 97598, 97597), surgical debridement (CPT code 11042 to 11047), E&M, and NPWT codes. Each code added will have its application, what’s included or not, and documentation requirements for clean claim submission.
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Three Main Categories of Wound Care CPT Codes
Wound care billing gets simpler once you know how CPT codes are organized.
- Active Wound Care Management (CPT Code 97597-97610)
- Surgical Debridement (CPT Code 11042-11047)
- Evaluation and Management (CPT Code 99202-99215)
Active Wound Care Management CPT Codes
Active wound care management codes handle non-surgical debridement and wound therapy. Most routine wound care billing uses codes from this category.
CPT Code 97597 – Where Most Wound Care Billing Starts
CPT 97597 covers selective debridement of open wounds measuring 20 cm² or less. Selective debridement means removing devitalized tissue while preserving healthy tissue. The provider chooses what to remove.
What’s included in CPT 97597:
- Sharp selective debridement (scissors, scalpels, forceps)
- High-pressure waterjet debridement (with or without suction)
- Topical applications and medications
- Wound assessment during the session
- Whirlpool therapy (when performed)
- Patient instructions for ongoing care
Use this code when removing fibrin, slough, necrotic epidermis or dermis, exudate, debris, or biofilm from the wound surface. The work stays at the surface level, with no cutting into subcutaneous tissue or deeper structures.
Required documentation:
- Instruments or techniques used
- Type of devitalized tissue removed
- Exact surface area treated (in cm²)
CPT Code 97598 – The Add-On You Can’t Bill Alone
The CPT 97598 wound care CPT code covers each additional 20 cm² beyond the first 20 cm². This code can’t stand alone, 97597 must be on the same claim.
Billing calculations:
| Wound Size | CPT Code Combination |
|---|---|
| 25 cm² | 97597 + 97598 (1 unit) |
| 50 cm² | 97597 + 97598 x2 (2 units) |
| 70 cm² | 97597 + 97598 x3 (3 units) |
| 100 cm² | 97597 + 97598 x4 (4 units) |
The “or part thereof” rule means even 1 cm² overcounts as a full unit. A 70 cm² wound has 50 cm² beyond the first 20 cm²; that’s three units of 97598, not two.
Billing 97598 without 97597 will be denied automatically.
CPT Code 97602 – When Debridement Isn’t So Selective
This wound care CPT code is for non-selective debridement. You’re removing tissue without distinguishing between viable and non-viable areas.
Methods covered:
- Wet-to-moist dressings
- Enzymatic debridement
- Abrasion techniques
What’s included:
- No anesthesia required
- Topical applications
- Wound assessment
- Patient instructions for ongoing care
Billing restriction: Facilities can usually report 97602, but many Medicare contractors don’t allow providers to bill it professionally. Check your local coverage rules first.
Confused about CPT code selection for debridement?
CPT Codes 97605, 97606, 97607, 97608 – Negative Pressure Wound Therapy
Negative pressure wound therapy removes fluid and promotes healing through controlled suction. Four codes cover NPWT based on equipment type and wound size.
| CPT Code | Equipment Type | Wound Size |
|---|---|---|
| 97605 | Durable Medical Equipment (DME) | ≤50 cm² |
| 97606 | Durable Medical Equipment (DME) | >50 cm² |
| 97607 | Disposable Equipment | ≤50 cm² |
| 97608 | Disposable Equipment | >50 cm² |
Whether you use durable or disposable equipment determines which code to use. All four codes include topical applications, wound assessment, and patient education.
Documentation requirements:
- Why is NPWT medically necessary
- Which previous treatments failed before starting NPWT
Payers examine these claims carefully, so documentation matters.
CPT Code 97610 – MIST Therapy (And When You Can’t Use It)
CPT 97610 is for low-frequency, non-contact ultrasound therapy, MIST therapy. This treatment stimulates healing without physical contact with the wound bed.
What’s included:
- Topical applications
- Wound assessment
- Patient instructions (billed per session)
Medicare restriction: Don’t bill 97610 if you did any other wound care CPT code on the same wound during that visit.
Cannot be billed with:
- 97597 or 97598 (selective debridement)
- 97602 (non-selective debridement)
- 11042-11047 (surgical debridement)
- Any other wound debridement codes for the same wound
If you’re debriding the wound, skip 97610.
Surgical Debridement CPT Codes
Use surgical debridement codes when cutting into tissue layers below the surface. These are depth-based codes, your selection depends on the deepest tissue you removed, not the wound’s total depth.
The Depth Rule
The most common coding mistake? Confusing wound depth with debridement depth. These aren’t the same.
Code based on the deepest tissue you removed, not the wound’s overall depth. A 5 cm deep wound debrided only to subcutaneous tissue gets coded as 11042, not something deeper.
The coding hierarchy:
- CPT 11042: Debridement to subcutaneous tissue (includes epidermis and dermis if removed)
- CPT 11043: Debridement to muscle and/or fascia (includes all shallower layers if removed)
- CPT 11044: Debridement to bone (includes all tissue layers above if removed)
Surface area matters. The primary wound care CPT codes cover the first 20 cm² or less and add-on codes cover each additional 20 cm² or part thereof.
For multiple wounds:
- Same depth: Add the surface areas together and bill once
- Different depths: Code the deepest wound first, then use modifier 59 for shallower wounds
CPT Code 11042 – Subcutaneous Debridement
CPT 11042 is for debridement into subcutaneous tissue, first 20 cm² or less. The code includes epidermis and dermis removal if you took those layers.
| Situation | Correct Code |
|---|---|
| Removed necrotic tissue at surface level with sharp technique | 97597 |
| Cut into subcutaneous tissue layer with surgical debridement | 11042 |
| Removed slough and fibrin from wound bed only | 97597 |
| Debrided through dermis into subcutaneous fat | 11042 |
The key difference is depth and technique. If you’re using surgical technique and cutting into subcutaneous tissue, you’re in 11042 territory.
Documentation requirements:
- Depth of debridement (must specify subcutaneous tissue)
- All tissue layers removed
- Surface area in cm²
- Surgical technique used
CPT Code 11043 – Muscle and Fascia Territory
This wound care CPT code is used when debriding muscle and/or fascia for the first 20 cm² or less. The code covers epidermis, dermis, and subcutaneous tissue if you removed them to reach the deeper layers.
This code is more intensive than 11042. Getting to muscle or fascia means cutting through multiple tissue layers.
What qualifies:
- Debridement exposing muscle tissue
- Debridement involving fascia (connective tissue layer)
- Removal of necrotic or infected tissue at these depths
Documentation must show:
- Specific depth reached (muscle, fascia, or both)
- All tissue layers removed
- Surgical technique and instruments used
- Surface area treated
CPT Code 11044 – All the Way to Bone
CPT 11044 covers debridement to bone for the first 20 cm² or less. This is the deepest and most extensive level of surgical debridement. The code includes all tissue layers above the bone if you removed them.
Use this code when you’re debriding infected or necrotic bone tissue, or when you must cut through all overlying tissue to reach bone level.
Documentation requirements:
- Confirmation that bone was debrided
- Description of bone condition (necrotic, infected, etc.)
- All tissue layers removed
- Surface area in cm²
This code carries the highest reimbursement in the surgical debridement series because of the complexity and depth involved.
The Add-On Codes: 11045, 11046, 11047
Each primary code has a corresponding add-on code for additional surface area beyond the first 20 cm².
| Primary Code | Add-On Code | What It Covers |
|---|---|---|
| 11042 (subcutaneous) | 11045 | Each additional 20 cm² at subcutaneous level |
| 11043 (muscle/fascia) | 11046 | Each additional 20 cm² at muscle/fascia level |
| 11044 (bone) | 11047 | Each additional 20 cm² at bone level |
Add-on codes cannot be billed alone. They must pair with their corresponding primary code.
Evaluation and Management (E/M) CPT Codes for Wound Care
E/M codes cover wound assessment visits where you’re evaluating the patient’s condition without performing a procedure, or when the evaluation is significant enough to bill separately from wound care.
New Patient E/M Codes (99202-99205)
Use the E/M CPT code for wound care when you’re seeing a patient for the first time for wound care evaluation.
| CPT Code | Time Range | Medical Decision Making | When to Use |
|---|---|---|---|
| 99202 | 15-29 minutes | Straightforward | Simple wound assessment, uncomplicated case |
| 99203 | 30-44 minutes | Low complexity | Wound evaluation with some comorbidities |
| 99204 | 45-59 minutes | Moderate complexity | Complex wound with multiple factors affecting healing |
| 99205 | 60-74 minutes | High complexity | Extensive evaluation, multiple wounds, complicated medical history |
Code selection depends on either the time spent or the complexity of medical decision-making. You can choose whichever method benefits you more, but document accordingly.
Established Patient E/M Codes (99212-99215)
Use these codes for follow-up visits with patients you’ve seen before for E/M CPT code for wound care.
| CPT Code | Time Range | Medical Decision Making | When to Use |
|---|---|---|---|
| 99212 | 10-19 minutes | Straightforward | Routine wound check, stable condition |
| 99213 | 20-29 minutes | Low complexity | Wound reassessment with minor changes |
| 99214 | 30-39 minutes | Moderate complexity | Significant wound changes or treatment plan modifications |
| 99215 | 40-54 minutes | High complexity | Complicated reassess |
When to Bill E/M With Wound Care Procedures
You can bill an E/M code on the same day as debridement, but only with modifier 25, and only if the evaluation was significant and separately identifiable.
E/M is separately billable when:
- You’re evaluating a new wound in addition to treating an existing one
- You’re managing comorbidities that significantly affect wound healing (diabetes control, infection management, vascular issues)
- The visit involves substantial evaluation beyond the decision to perform the procedure
E/M is NOT separately billable when:
- You’re just examining the wound before debriding it
- The evaluation is minimal and directly related to deciding whether to debride
- You’re documenting routine wound status as part of the procedure
Documentation requirements for E/M with modifier 25
Document the E/M service separately from the procedure note. Make it clear what additional evaluation you performed beyond the wound care itself. Many payers scrutinize modifier 25 claims, so specificity matters.
Conclusion
Accurate wound care coding requires three things: choosing the right code based on tissue depth removed, calculating surface area correctly, and documenting thoroughly. Remember the depth rule, code what you removed, not the wound’s total depth. This prevents the most expensive billing errors.
You can apply these wound care CPT code guidelines to your very next claims. Make sure to measure wounds in centimeters, pair add-on codes with primary codes, and document specific details instead of generic phrases. Such small improvements in coding accuracy lead to cleaner claims and better reimbursement; you just need to be consistent.
