Introduction
Wound care procedures, including debridement and skin substitutes, are essential for managing chronic wounds, ulcers, and traumatic injuries. Proper CPT coding ensures accurate reimbursement and prevents denials due to incorrect modifier use or bundling issues. This guide covers key CPT codes for wound debridement, skin grafts, and negative pressure wound therapy, along with billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.
Understanding Wound Care & Debridement Coding
- Wound debridement – The removal of necrotic or infected tissue to promote healing.
- Skin substitutes & grafting – Used to cover wounds and facilitate skin regeneration.
- Negative pressure wound therapy (NPWT) – A vacuum-assisted therapy to promote wound healing.
CPT Codes for Wound Care & Debridement
Wound Debridement CPT Codes
- 97597 – Debridement (removal of devitalized tissue) for wounds up to 20 cm².
- 97598 – Debridement of wounds greater than 20 cm² (each additional 20 cm²).
- 11042 – Debridement, subcutaneous tissue, first 20 cm².
- 11045 – Debridement, subcutaneous tissue, each additional 20 cm².
- 11043 – Debridement, muscle/fascia, first 20 cm².
- 11046 – Debridement, muscle/fascia, each additional 20 cm².
- 11044 – Debridement, bone, first 20 cm².
- 11047 – Debridement, bone, each additional 20 cm².
Skin Substitutes & Skin Grafting CPT Codes
- 15271 – Skin substitute application, first 25 cm² (trunk, arms, legs).
- 15272 – Skin substitute application, each additional 25 cm².
- 15275 – Skin substitute application, first 25 cm² (face, scalp, hands, feet, genitalia).
- 15276 – Skin substitute application, each additional 25 cm².
- 15110 – Epidermal autograft, first 100 cm².
- 15115 – Dermal autograft, first 100 cm².
Negative Pressure Wound Therapy (NPWT) CPT Codes
- 97605 – NPWT, wound < 50 cm².
- 97606 – NPWT, wound ≥ 50 cm².
- 97607 – NPWT, durable medical equipment (DME), wound < 50 cm².
- 97608 – NPWT, DME, wound ≥ 50 cm².
Billing Guidelines & Modifier Usage
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Common Modifiers:
- -25 – Used when an E/M service is performed on the same day as a procedure.
- -59 – Distinct procedural service (if multiple interventions are performed).
- -LT/-RT – Indicates laterality for bilateral procedures.
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Bundling Considerations:
- Debridement codes (11042-11047) should not be reported with NPWT codes (97605-97608) unless treating different wounds.
- Skin substitute applications (15271-15276) may be bundled depending on payer policies.
Common Denials & How to Avoid Them
- Medical Necessity Denials: Ensure documentation includes wound size, depth, and evidence of infection or necrosis.
- Modifier Use Issues: Append -59 or -25 modifiers correctly when appropriate.
- Duplicate Claim Rejections: Avoid submitting multiple debridement codes for the same wound on the same day unless properly justified.
Final CPT Code Table: Descriptions & RVUs
| CPT Code | Description | RVU |
|---|---|---|
| 97597 | Debridement, up to 20 cm² | 0.90 |
| 97598 | Debridement, > 20 cm² (each additional 20 cm²) | 1.20 |
| 11042 | Debridement, subcutaneous tissue, first 20 cm² | 1.50 |
| 11045 | Debridement, subcutaneous tissue, each additional 20 cm² | 0.85 |
| 11043 | Debridement, muscle/fascia, first 20 cm² | 1.90 |
| 11046 | Debridement, muscle/fascia, each additional 20 cm² | 1.10 |
| 11044 | Debridement, bone, first 20 cm² | 2.40 |
| 11047 | Debridement, bone, each additional 20 cm² | 1.30 |
| 15271 | Skin substitute application, first 25 cm² (trunk, arms, legs) | 2.00 |
| 15272 | Skin substitute application, each additional 25 cm² | 1.25 |
| 15275 | Skin substitute application, first 25 cm² (face, scalp, hands, feet, genitalia) | 2.20 |
| 15276 | Skin substitute application, each additional 25 cm² | 1.35 |
| 15110 | Epidermal autograft, first 100 cm² | 3.10 |
| 15115 | Dermal autograft, first 100 cm² | 3.50 |
| 97605 | NPWT, wound < 50 cm² | 1.40 |
| 97606 | NPWT, wound ≥ 50 cm² | 1.80 |
| 97607 | NPWT, DME, wound < 50 cm² | 2.10 |
| 97608 | NPWT, DME, wound ≥ 50 cm² | 2.50 |
Conclusion
Accurate CPT coding for wound care and debridement is essential for maximizing reimbursement and preventing denials. Understanding modifier use, bundling rules, and payer-specific guidelines will help ensure accurate claims.
If this guide was useful, check out our other procedure CPT coding guides on skin grafting, negative pressure wound therapy, and hyperbaric oxygen therapy!