Q&A: CPT coding for selective and nonselective wound debridement

Q: How are selective and nonselective wound debridement procedures documented in the medical record and coded using CPT?

A: A physician can debride a wound to remove dead, damaged, or infected tissue so the remaining healthy tissue can better heal. 

Selective debridement is the removal of nonviable tissue. Provider documentation to support selective debridement should include the following:

• Removal of specific targeted areas of non-viable tissue which limits healing from a wound along the margin of the viable tissue
• A clear description of the instruments used for debridement (e.g., high-pressure waterjet, scissors, scalpel, forceps)
• An objective assessment of the wound including drainage, color, texture, temperature, vascularity, conditions of surrounding tissue, and size of the area to be targeted for debridement

Selective debridement is reported using CPT code 97597 and add-on code 97598:

• 97597, debridement open wound, including topical application(s), wound assessment, user of whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq. cm or less
• Add-on code 97598, …each additional 20 sq. cm, or part thereof. List separately in addition to the code for the primary procedure 

CPT code 97597 is used to report selective debridement of the first 20 sq. cm of wound surface area and add-on code 97598 for each additional 20 sq. cm debrided.

Nonselective debridement is the gradual removal of nonviable tissue and is generally not performed by a physician. Documentation to support nonselective debridement should include the following:

• Nonsurgical debridement by brushing, irrigation, scrubbing, or washing of devitalized tissue, necrosis, or slough (e.g., whirlpool therapy, medicated dressings, pulse lavage)
• The type of technique utilized (e.g., wet-to-moist, enzymatic, abrasion)
• Thorough objective assessment of the wound as described in guidance on selective debridement

Nonselective debridement is reported using CPT code 97602 (removal of devitalized tissue from wound[s], non-selective debridement, without anesthesia [e.g., wet-to-moist dressings, enzymatic, abrasion, larval therapy] including topical application[s], wound assessment, and instructions[s] for ongoing care, per session).  

Editor’s note: Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, AHIMA-approved ICD-10-CM/PCS trainer, and Felisa Tennant, MIS, RHIA, CCS, CHP, coding education specialist at TrustHCS in Springfield, Missouri, answered this question during the HCPro webinar Navigating Complex ED Coding and Billing Scenarios. 

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