CCI UPDATE 97597-97598: CCI Will Correct Debridement Glitch

Hang on to your claims for these wound care management codes.

As most veteran coders know, you can’t report an add-on code unless you report it along with its “parent code” on the same claim. But an NCCI glitch has made it impossible for you to collect for both the debridement add-on code 97598 and its partner code 97597 — creating denied claims and confusion for practices that perform active wound care management. However, a new announcement indicating that the NCCI is fixing the problem should ease your coding angst.

The American Podiatric Medical Association (APMA) issued a release on its Web site stating that the National Correct Coding Initiative (NCCI) edits currently bundle the following two codes together:

97597 — Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less
+97598 — …each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

This edit bundle has an indicator of “0,” meaning that no modifier can separate these codes. Fortunately, the APMA caught the error and contacted the NCCI director about it.

“The NCCI is currently working on a solution and recommends that APMA members delay submission of claims reporting combination of CPT 97597 and CPT 97598 until the NCCI replacement file is in place and implemented by CMS,” the APMA’s statement says. “The April 1, 2011 version of NCCI does not contain this edit error.”

The APMA has not yet gotten word on whether Medicare contractors will automatically reprocess claims that were paid in error…

Read More »

10060 Won’t Wash for Some I&Ds

Careful: A pilonidal cyst I&D is a separate animal.
Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about […]

Related articles:

  1. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the…
  2. Know What Separates FBR From E/M or Lose $80 in Pay Here’s why ‘incision’ with non-scalpel instrument could be an…
  3. Wound Closure Coding: Make the Simple, Intermediate DistinctionAccounting for depth is a tricky task when coding closure….
Read More »

Surgical Coding Mysteries: The Case of the Separate Mesh

Beware Separate Mesh Removal
Question: The surgeon performed the following: Made 10 cm supraumbilical transverse incision with 15-blade scalpel carried down through subcutaneous tissue using Bovie. Used combination electrocautery and blunted dissection to isolate area of scar tissue on patient’s right side. Noted sutures from previous umbilical hernia repair and mesh from right-lower abdominal hernia repair.
Excised […]

Related articles:

  1. Don’t Mesh Up Your +57267 CodingAn ob-gyn doc with coding know-how tells us how to…
  2. What a Mesh! (+57267)Take this advice to avoid messing up your mesh coding:…
  3. Surgical Coding: Modifiers 58, 78, and 79SURGICAL MODIFIER CHOICES Surgery Modifier Choices are Key to Surgery…
Read More »

97597 or 11040 for Partial Thickness Excisional Debridement?

Question: Encounter notes indicate that the physician performed a partial thickness excisional debridement of a patient’s wound. Should I use 97597 or 11040 for this service?
Answer: Since the physician performed the debridement and the notes indicate that it was an excisional debridement, you should report 11040 (Debridement; skin, partial thickness) for the service.
Key: Physician role should […]

Related articles:

  1. Do You Code for Surgical Debridement or AWCM? We’ve got the answer. Straight from the horse’s mouth….
  2. Should I Use Modifier 76 for a Repeat Procedure? Question: A patient has pressure sores that were 20…
  3. OK to Code Debridement With Consult?Question: Can you charge for an inpatient consult and a bedside…
Read More »
Share on facebook
Share on twitter
Share on linkedin
Share on whatsapp

Most Popular: