Billing and Coding: Wound and Ulcer Care

Debridement and active wound care codes (CPT 97597, 97598, 97602, 11000-11012, 11042-11047, etc.) are payable when the medical record documents medically necessary selective or surgical removal of devitalized tissue and the CPT code reflects the deepest tissue removed. Dressings, dressing changes, and related supplies are bundled into many wound care and debridement codes and may not be billed separately; specific bundling, mutually exclusive, inpatient-only, modifier, and documentation rules (including ICD-10 specificity, therapy modifiers, and documentation of depth or symptomatic lesions) must be followed. Frequency limits include one CPT 97610 per day per qualifying wound, limits on aggregate debridements per day (policy allows one aggregate independent tissue debridement per day and denies >4 aggregate debridements for one or both feet without supporting documentation), and several mutually exclusive billing restrictions (e.g., do not report 97602 with 97597/97598 or with 11042-11047 for the same wound/date).