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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.

Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).