02/24/2026    PM News Subscriber

Wound Care Code

Query: I have been using this code for wound care:
97597 = Debridement (e.g., high pressure waterjet
with/without suction, sharp selective debridement
with scissors, scalpel and forceps), open wound
(including topical application(s), wound
assessment, use of whirlpool when performed and
instruction(s) for ongoing care), first 20 sq cm
or less.

Recently it gets rejected as:
PAYER RESPONSE: NGSEDIT SUBMITTED THERAPY
PROCEDURE CODE IS MISSING
REQUIRED MODIFIER GP, GO, OR GN.

GP - Services delivered under a Physical Therapy
plan of care
GO - Services delivered under an Occupational
Therapy plan
GN - Services delivered under a Speech Therapy
plan

Has the code changed? GP seems closest but then do
we need a physical therapy plan of care on file?

PM News Subscriber

Response from codinghelpline.com: The denial is
due to a missing therapy modifier (GP, GO, or GN),
not a code change. National Government Services
(NGS) LCD L33631 has not been revised since
01/01/2020, and there are no new policy changes
requiring different coding. NGS Medicare LCD can
be found here: https://www.cms.gov/Medicare-
coverage-database/view/lcd.aspx?
lcdId=33631&ver=51.

The GP/GO/GN modifiers are generally required when
therapy services are provided under a therapy plan
of care, typically by non-physician providers (PT,
OT, SLP). This edit most commonly occurs when
services are performed for a patient in a Nursing
Facility. In that setting, therapy services
(including CPT 97597) are expected to be covered
under the facility’s therapy plan of care.

If the patient resides in a nursing facility,
Medicare may consider the place of service to be
the facility—even if you saw the patient in your
office. GP would only be appropriate if the
service was provided under a physical therapy plan
of care and one is on file.

Without clarification of the place of service and
provider type identifier, this is the most likely
explanation for the rejection.

David J. Freedman, DPM< Silver Spring, MD

Other messages in this thread:

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11/03/2005    

New 2006 Wound Care Codes (Michael King, DPM)

RE: New 2006 Wound Care Codes (Michael King,
DPM)
From: Marc Jay Pinsky, DPM

Dr. Michael King writes that code 15430 is the
code to be used when applying Oasis.
When Oasis was originally introduced, it was
considered to be a xenograft - as it was
material from porcine submucosal tissue.
However, when the material was purchased from
its original manufacturer, and resold, it was
then classified as a 'wound care dressing' , and
not a graft material.

Medicare had put out a notice stating that Oasis
was a wound care dressing and was not to be
billed as a xenograft. This finding has been in
effect now for many years.

Has a new finding, or CAC ruling been introduced
which changes the status quo? If so, please
send me the source of your information. I would
LOVE to be able to bill for the material, rather
than eating it as part of an extended office
visit.

Marc Jay Pinsky, DPM, cvpps@totalusa.net,
Richmond, VA

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11/01/2005    Lloyd S. Smith, DPM, Michael King, DPM

New Wound Care Codes, APMA Coding Manual

RE: New Wound Care Codes, APMA Coding Manual
From: Lloyd S. Smith, DPM, Michael King, DPM

At the just completed APMA Region 1 Seminar, the
new wound care codes for 2006 were reported on
by the APMA coding team. 43 codes have been
revised and replaced by CPT and RUC by a joint
effort of APMA, ASPS (plastics) and ABA (burn).
The codes of greatest relevance to podiatrists
are 15340, 15341 and 15430 respectively.

CPT 15340 and 15341 are to be used for Apligraf
and the now discontinued
Dermagraft. They are expected to be 10-day
globals. The exact reimbursement by Medicare is
not yet known, but the RUC has valued them as a
result of APMA's input.

CPT 15430 will be used for Oasis and is expected
to have a 90-day global with a yet to be
determined value.

There is also a new Category 1 code for ESWT.

Watch for the soon to be released APMA Coding
Manual for full details on this and many other
coding changes for 2006.

Lloyd S. Smith, DPM, APMA RUC Representative,
Immediate Past President, APMA


I would strongly encourage all APMA members to
purchase and download (when available in
December) the APMA Coding manual. This concise
coding guide will become the staple for daily
use in everyone's practice.
The manual, a real member benefit, should
substantially streamline everyone's ability to
properly code for all services rendered in any
setting.
This manual is being offered at a reasonable
cost and ALL proceeds from its distribution will
go directly to the APMA Educational Foundation.
APMA must pay royalties to the AMA for the use
of the CPT codes, and this is built into the
cost.

Please take advantage of this fine member
benefit.

Michael King, DPM, APMA BOT, AMA CPT Advisor,
mjking@apma.org

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11/18/2004    Bret M. Ribotsky, DPM

New and Revised Wound Care Codes

New and Revised Wound Care Codes

The final rule establishes values, which were
recommended by the RUC HCPAC review board, for
two of the new CPT codes for wound care, which
will be effective January 1, 2005. These CPT
codes are as follows:

CPT Code 97597 Removal of devitalized tissue
from wound(s), selective debridement without
anesthesia (eg, high pressure waterjet
with/without suction, sharp debridement with
scissors, scalpel and forceps), with/without use
of whirlpool, topical application(s), wound
assessment, and instruction(s) for ongoing care,
per session; total wound(s) surface area less
than or equal to 20 square centimeters.
CPT Code 97598 Removal of devitalized tissue
from wound(s), selective debridement without
anesthesia (eg, high pressure waterjet
with/without suction, sharp debridement with
scissors, scalpel and forceps), with/without use
of whirlpool, topical application(s), wound
assessment, and instruction(s) for ongoing care,
per session; total wound(s) surface area greater
than 20 sq. cm.
RVUs for 97597 and 97598 were assigned as
follows:

Physician Non-
Facility Facility
Malpractice Total

97597 0.58
0.66 0.66
0.05 1.29

97598 0.80
0.79 0.79
0.05 1.64

There were two other wound codes for which CMS
did not establish values because they viewed
them as bundled services and not separately
payable.

These two codes are the following:

CPT Code 97605 Negative pressure wound therapy
(eg, vacuum assisted drainage collection),
including topical application(s), wound
assessment, and instruction(s) for ongoing care,
per session; total wound(s) surface area less
than or equal to 50 sq. cm.

CPT Code 97606 Negative pressure wound therapy
(eg, vacuum assisted drainage collection),
including topical application(s), wound
assessment, and instruction(s) for ongoing care,
per session; total wound(s) surface area greater
than or equal to 50 sq. cm.

CMS did not accept the RUC HCPAC review board
recommendations because they believed that these
codes do not contain physician work. They state
that if negative pressure wound therapy service
does not encompass selective debridement, it
represents a dressing change and is not
separately billable. When the negative pressure
wound therapy service includes the need for
selective debridement, CMS considers the
services to be bundled into CPT 97597 or 97598,
the new debridement codes.

Source: Bret M. Ribotsky, DPM

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11/17/2004    Michael King, DPM

New CMS Wound Care Codes (Bret Ribotsky, DPM)

RE: New CMS Wound Care Codes (Bret Ribotsky, DPM)
From: Michael King, DPM

In reference to Dr Ribotsky's post of 11/18/04
and the CMS Final Rule for the 2005 Medicare
physician fee schedule that included a
discussion on new wound care codes,

It is important to note that the first two
codes mentioned, 97597 and 97598 are not
designed to be used by physicians. That includes
US. Those codes were brought about in the CPT
world by the physical therapy community to use
for wound debridement when their state laws
allow such. The first version of codes they
made, 97601 and 97602 created great confusion,
if not havoc for many DPMs around the country
when some private payers forced them to use
these PT codes instead of the appropriate 11040-
44 codes.

Physicians should use the appropriate
debridement codes as mentioned 11040-44 when
debriding ulcerations of the lower extremity.

Michael King, DPM
APMA CPT Advisor
MKFtDoc@aol.com

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07/26/2004    Robert Mohr, DPM

Wound Care Codes 97601/2

Query: Wound Care Codes 97601/2

Has anyone had any experience using the wound
management CPT codes 97601 and 97602? Can you
bill them together with an office visit for
weekly wound care f/u visits or are they meant
to be used independently for dressing changes?

Robert Mohr, DPM
University Podiatry Group
Los Angeles, CA

Codingline Response: 97601 and 97602 were
designed for non-physician use such as PT and OT
types (yes, I sadly said OT) and not for
physician use. Use the 11040 series codes.

It is not part of this discussion, but it
seriously galls me that non-surgeons are now
being considered wound care experts and allowed
to use sharp instruments. Not on my hand they
wouldn't!

Ken Malkin, DPM
Caldwell, NJ