Over 6.5 million Americans suffer from chronic wounds annually. This is costing the healthcare industry more than $25 billion per year, according to the Journal of Wound Care. Even with a number this great, wound care claims face higher denial rates than other medical services.
The primary reason is coding confusion around procedures like CPT 97602, where a single documentation mistake can reject a legitimate wound debridement claim. Modifiers, reimbursement rules, and medical necessity documentation create challenges. This guide clarifies the code’s description, explains when to use a modifier, current payment rates, and provides the documentation needed to secure proper reimbursement.
CPT 97602 is used for the removal of devitalized tissue from wounds via non-selective debridement performed without anesthesia. This procedure removes both healthy and necrotic tissue without discrimination, including topical applications, wound assessment, and patient instructions for ongoing care as bundled services.
Yes, modifiers are required in some cases, such as modifier 59 applies for multiple distinct wounds and modifier 25 for same-day E/M services.
CPT 97602 encompasses several non-selective wound debridement techniques that mechanically or chemically remove devitalized tissue without targeting specific layers. Understanding which method applies to your clinical scenario ensures accurate coding and proper reimbursement.
| Debridement Method | Description |
|---|---|
| Wet-to-Moist Dressings | Moist gauze applied to wound, allowed to dry partially, then removed along with adherent necrotic tissue |
| Enzymatic Debridement | Topical agents like collagenase (SANTYL) or papain-urea that chemically break down necrotic tissue |
| Mechanical Abrasion | Gentle scrubbing or high-pressure irrigation to remove loose debris; includes whirlpool therapy |
| Larval Therapy | Medical-grade maggots that consume necrotic tissue while preserving healthy tissue |
Understanding CPT 97602 reimbursement is critical because payment rules differ significantly based on practice setting and provider type.
The key distinction between CPT 97597 vs 97602 is scanario. CPT 97597 uses sharp instruments to remove only necrotic tissue, while CPT 97602 employs non-selective methods that remove both healthy and devitalized tissue.
| Feature | CPT 97597/97598 (Selective) | CPT 97602 (Non-Selective) |
|---|---|---|
| Typical Use | Wounds requiring precise debridement | Wounds with mixed tissue types |
| Method | Sharp debridement with instruments (scissors, scalpel, forceps) | Wet-to-moist dressings, enzymatic agents, mechanical abrasion |
| Tissue Removal | Targets only necrotic/devitalized tissue | Removes both healthy and necrotic tissue |
| Precision | Selective and controlled | Non-discriminatory removal |
| Measurement | Billed by surface area (20 sq cm increments) | Per session, regardless of wound size |
| Add-on Code | 97598 for each additional 20 sq cm | No add-on code available |
Important Note:
You cannot bill CPT 97597 and CPT 97602 for the same wound on the same day, as they represent mutually exclusive approaches to wound debridement.
Proper documentation separates paid claims from denials when billing CPT 97602. Medicare and commercial payers require detailed records that justify medical necessity and demonstrate the scope of services provided. Missing even one critical element can trigger claim rejections or audits.
Medical necessity requires clear justification explaining why non-selective wound debridement was clinically appropriate for the patient’s condition. Documentation must demonstrate the wound contained devitalized tissue impeding healing, the chosen method was suitable for the wound type, and the procedure promoted wound progression toward closure or improved patient outcomes.
Getting CPT 97602 right isn’t complicated once you know the rules. Document your wound assessments thoroughly, use the correct modifiers based on who’s performing the service, and make sure your notes show why non-selective debridement was necessary. These basics keep claims clean and denials low, which means steadier cash flow for your practice.
MedCare MSO takes the guesswork out of wound care billing. We handle the coding complexities, spot documentation gaps before they become problems, and work denials so you don’t lose revenue on legitimate services. If wound care billing is consuming your team’s time or your denial rate is higher than it should be, let’s talk about how we can help.
By outsourcing your billing services to us, you can expect revenue growth of up to 20%
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