Ask a Rev Cycle Expert: CPT® 11042 Vs. 97597?
My question is in regard to debriding hypergranulation tissue. There is some confusion as to which CPT® code we should be using for a debridement of hypergranular tissue. My provider feels if there wasn't much hypergranular tissue removed in debridement that I should not bill CPT® 11042; he feels I should code 97597 instead. If we could please get your guidance on which code to use.
Current Procedural Terminology (CPT®) code 11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less is surgical debridement, meaning an instrument such as a scalpel, forceps, scissors, or tissue nippers are used to remove the dead tissue. Additionally, there must be tissue removed from the subcutaneous layer, so the treatment is below the epidermis/dermis level. This procedure may be reported by a physician or nonphysician practitioner (NPP).
If the dead tissue is not surgically excised, or if only the epidermis and/or dermis is involved, then CPT® code 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 would be appropriate. This procedure may be performed by facility clinical staff under the direction of a physician or NPP.
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