Q&A: CPT coding for wound care assessment followed by debridement

Q: A patient presents to a wound care clinic for assessment of a 15 sq. cm open wound. A nurse evaluates the wound for size, depth, and evidence of inflammation and performs sharp selective debridement. Would it be appropriate to bill an E/M code and if so, should we report modifier -25?

A: In this case, an E/M code would not be appropriate unless unforeseen circumstances arise, or the patient presents with new wound or health issue requiring assessment. Because an E/M code isn’t necessary, modifier -25 wouldn’t apply.

Remember, modifier -25 is used to indicate a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service. It can only be appended to E/M codes, not procedural codes, and may only be reported if the provider performs an E/M service and a minor surgical procedure on the same date.

In this scenario, the coder would only report CPT code 97597 (debridement open wound, including topical application, wound assessment, user of whirlpool, when performed, and instructions for ongoing care, per session, total wound surface area; first 20 sq. cm or less). The provider documentation should state that scissors, a scalpel, or forceps were used to remove devitalized tissue from the epidermis and/or dermis.

Editor’s Note: Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, CPAR, CPC, COC, and Sarah L. Goodman MBA, CHCAF, COC, CCP, FCS, answered this question during the HCPro webinar, “2019 Modifier Update: Review New NCCI Guidance.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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