97597 CPT Code for Wound Care: When & How to Use It

Have you seen the set of codes in your medical practice? Do you know their importance? You must think these complex sets of numbers are useless. These complex numbers are Current Procedural Terminology (CPT) codes. These codes play an important role in medical billing and streamline complex billing tasks.

In a healthcare organization, every department has a particular set of codes. For example, the wound care department has a specific series of numbers that will be used only for this department. Medical billing companies like SysMD use these codes in the claims and bills of patients who come for wound diseases.

In this blog post, we will discuss the uses and significance of the 97597 CPT code in medical billing. We will describe the documentation requirements, mistakes, and recent updates in wound care billing.

What is the 97597 CPT Code?

It is a specific code used in wound care medical billing. It is used for the debridement of wounds such as the removal of devitalized tissue such as necrotic, fibrinous, or infected tissue. Sharp instruments such as scalpels and scissors are used for the debridement of wounds.  

In this department, healthcare providers use high-pressure water jets and other advanced methods to treat wounds. 97597 CPT code applies to wounds measuring up to 20 cm² in total surface area.

Use of CPT Code 97597 in Medical Billing:

This code is used when wound debridement is medically necessary. For example, a diabetic foot wound falls under this category. CPT code 97597 is used to promote healing, reduce infection risk, and prepare the wound bed for further treatment.

CPT codes 97597 vs. 97598

In the wound care billing department, another commonly used code is 97598. Both codes are closely related. That is why, most coders use them interchangeably which leads to claim denials and false bills. You should understand the difference between both codes and their uses:

• 97598 code is used for wounds that exceed the area of 20 cm². On the other hand, the 97597 code is used up to area of 20 cm².
• You cannot use the 97598 code alone, but it is always used with the 97597 code.

97597 CPT code description: When to Use?

In hospital code charts, every code is described with detailed descriptions. The 97597 CPT code description is as follows:

97597 – Debridement (e.g., high-pressure water jet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound surface area up to 20 cm².

Requirements for Incorporating Wound Care Codes:

You should know the complete requirement of using wound care wounds especially when you work as a biller or coder in a hospital. You should incorporate the right code with the accurate condition of the patient.

Some requirements that you should fulfill before assigning this specific wound care CPT are as follows:

• You should note the size and depth of the wound before and after debridement.
• Mention the type of tissue that the doctor removed from the patient. For example, the tissue was necrotic, fibrinous, exudate, debris, or biofilm.
• You should write down the method used for the debridement. For example, sharp, enzymatic, or high-pressure irrigation.
• You can add a photograph of the procedure as evidence for payer companies. If it is applicable in your hospital.
• You should add the medical necessity statement by the doctor. It means that mention the reason that the doctor gave for the debridement.

Some billing tips that can help you incorporate a CPT 97597 code in the patient data are as follows:

• Do not bill CPT 97597 many times for different wounds treated in the same session. Instead, include them in one single bill.
• You should use modifiers (e.g., 59 for distinct procedural services) correctly especially when a lot of procedures are performed on the wound.

When you do not fulfill all the requirements for the 97597 CPT code, insurance companies will reject your claims. Thus, your reimbursement rate will decrease.

Common Mistakes in Coding for Wound Care Billing:

Are you facing a financial crisis because of wound care medical billing? Then, you should spot mistakes in your billing system and rectify them.

Some common mistakes in wound care medical billing are as follows:

Using CPT 97597 for Non-Selective Debridement:

In the above 97597 CPT code description, we discussed that this code is only used in selective debridement. Sometimes, coders put this code in non-selective debridement. It means that non-selective methods such as wet-to-dry dressings or autolytic debridement were used for wound healing. 97602 CPT code will be used for these methods instead of 97597.

Incorrect Use of CPT 97598

Sometimes, coders use the 97598 CPT code alone. It is an add-on code and will always be used with 97587 codes.

Incomplete Documentation:

When patient documents and information are not complete, billers cannot determine the accurate code according to the patient's condition, Thus, incomplete documentation leads to claims denials of wound care bills.

Billing Per Wound Instead of Per Session:

As we discussed above in billing tips, billing of wound care patients will be based on number of wounds instead of the number of visits. When billers do not combine wound areas and do not mention with 97598 code, insurance companies reject these claims to pay.

All the above mistakes can lead to your department's financial crisis. So, avoid these mistakes in your billing tasks.

Medicare and Insurance Policies for 97597 CPT Code:

Do you know who assigns CPT codes for different departments of hospitals? It is Medicare that assigns billing codes and guidelines for incorporating these codes. Insurance companies also provide specific guidelines for every code and medical billing department.

Medicare guidelines are:

• Medicare encourages to use of CPT 97597 when it is necessary medically.
• All hospitals should complete documentation procedures related to wound severity and treatment necessity.
• Medicare does not reimburse for experimental wound care treatments under CPT 97597.

Insurance Policies:

• All insurance companies vary in their guidelines, but most firms follow Medicare guidelines.
• Some companies need prior authorization for wound debridement.
• Coverage restrictions may apply based on wound chronicity and treatment frequency.

Case Studies:

Some case studies that show the usage and working of 97597 codes are as follows:

Case-1:

A patient presents with a diabetic foot ulcer measuring 15 cm² with necrotic tissue. The physician performs sharp debridement.

CPT Code Used: 97597 (wound is under 20 cm²).

Case-2:

A patient has a pressure ulcer measuring 35 cm² requiring sharp debridement.

CPT Codes Used: 97597 (first 20 cm²) + 97598 (additional 15 cm²).

Recent Updates in Wound Care Billing:

ADA and CMS update all CPT codes regularly. They also give some updates in 2025 so that healthcare organizations can use them in their daily billing tasks. Some recent updates in wound care medical billing are as follows:

• 2025 CMS Updates:

They advised hospitals to increase observation of medical necessity documentation.

• Electronic Submission Encouraged:

They suggest insurance companies accept digital claims with photographic evidence.

• Telehealth Consultations for Wound Care:

Now, some payers allow pre-evaluation via telehealth before approving in-person debridement claims.

Conclusion:

In conclusion, the Accurate 97597 CPT Code is essential for effective wound care billing. You can ensure compliance, avoid denials, and secure reimbursement with an accurate code. You can streamline the medical billing process and enhance patient care outcomes by understanding when and how to use 97597 and 97598.

Further, you should also follow proper documentation practices, and stay updated with Medicare and insurance policies to streamline Wound care medical billing.