Billing and Coding: Wound Care

This billing and coding guidance describes appropriate use and billing for active wound care and surgical debridement CPT codes (e.g., 97597-97608, 11000-11047, 97610), requiring an ICD-10-CM diagnosis linked to the procedure and documentation that supports the depth, surface area, and medical necessity for the selected code. Many supplies and dressing changes are packaged into debridement and active wound care codes and are not separately reimbursable; specific billing rules include bundled payment for 97602 (physicians), inpatient-only status for certain necrotizing debridement codes, and a limit of one 97610 per qualifying wound per day.

"Claims must be submitted with an ICD-10-CM code that represents the reason the procedure was done, billed to the highest level of specificity and linked to the procedure code."

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