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Wound Care
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Priority: 100
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# Quick Guide: Medical Coding for Wound Care
Assume Place of Service (POS) 31 – Skilled Nursing Facility. ([CMS][1])
---
## Wound Measurement (what to document every time)
Length x Width x Depth (cm): longest head-to-toe length, widest width perpendicular to length, and deepest point for depth. Use the clock-face method to note tunneling/undermining (e.g., “2.5 cm at 3 o’clock”). ([HQIN][2])
Surface area (cm²): Length × Width. Use this to pick base vs. add-on codes. ([Swift][3])
Multiple wounds: add the surface areas of wounds treated to the same depth; don’t combine areas from different depths. ([CMS Downloads][4])
> Tip: Photograph (if policy allows), record drainage/odor, tissue types, signs of infection, and pain—these support medical necessity and code selection.
---
## Picking the right wound service family
1. Selective/active debridement (e.g., biofilm, fibrin, slough removal without cutting into viable tissue) → 97597/97598.
2. Excisional/surgical debridement by depth of tissue actually removed → 11042–11047 (subQ / muscle-fascia / bone).
> Don’t report 97597–97598 with 11042–11047 for the same wound; choose by the deepest tissue removed. ([CMS][5])
---
## CPT breakdown: base vs. add-on (per session)
| Service family | Base code (first 20 cm² or less) | Add-on code(s) (each additional 20 cm² or part thereof) |
| ----------------------------------------- | -------------------------------- | ----------------------------------------------------------- |
| Selective/active debridement | 97597 | +97598 ([AAPC][6]) |
| Excisional debridement – Subcutaneous | 11042 | +11045 ([AAPC][7]) |
| Excisional – Muscle/fascia | 11043 | +11046 ([AAPC][8]) |
| Excisional – Bone | 11044 | +11047 ([AAPC][9]) |
How to count units quickly
Total surface area at the same depth →
If ≤ 20 cm² → bill base only.
If > 20 cm² → bill base + `ceil((total area − 20) / 20)` units of the add-on (because codes allow “or part thereof”). ([AAPC][8])
Example A – selective debridement: Three superficial wounds totaling 38 cm² → 97597 x1 + 97598 x1.
Example B – excisional debridement: SubQ areas totaling 26 cm² → 11042 x1 + 11045 x1. If a separate muscle wound of 12 cm² was also debrided → add 11043 x1 (don’t combine its area with subQ). ([CMS Downloads][4])
---
## Adding the E/M code (when appropriate)
Use Nursing Facility E/M codes when you perform and document a separately identifiable visit in the SNF on the same date as a wound procedure:
Initial NF care: 99304–99306
Subsequent NF care: 99307–99310
Discharge day management: 99315–99316
Select level by 2023 E/M guidelines (MDM or time). If you also perform a debridement, append modifier 25 to the E/M only when the visit is significant and separately identifiable beyond the pre/post-op work of the procedure. ([American Medical Association][10])
Level of MDM Amount and/or Complexity of Data to be Reviewed and
(Based on 2 out of Number and Complexity Analyzed Risk of Complications and/or Morbidity or Mortality of
3 Elements of of Problems Addressed Each unique test, order, or document contributes to the Patient Management
MDM) combination of 2 or combination of 3 in Category 1 below.
Straightforward 99304/99307 Minimal 1 self-limited or minor problem Minimal or none Minimal risk of morbidity from additional diagnostic testing or
treatment
Low 99304 99308 Low 2 or more self-limited or minor problems 1 stable chronic illness 1 acute, uncomplicated illness or injury 1 stable, acute illness 1 acute, uncomplicated illness or injury requiring
hospital inpatient or observation level of care OTC Drugs, PT/OT
Moderate 99305 99309 Moderate 1 or more chronic illnesses with exacerbation, progression, or side effects of treatment 2 or more stable chronic illnesses 1 undiagnosed new problem with uncertain
prognosis 1 acute illness with systemic symptoms 1 acute complicated injury
High 99306 99310 High 1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment 1 acute or chronic illness or injury that poses a threat to life or bodily function
Extensive
---
## Place of Service
Assume POS = 31 (Skilled Nursing Facility) on the claim (as you requested). Note: some payers distinguish NF (POS 32) vs. SNF (POS 31); follow payer policy if told otherwise. ([CMS][1])
---
## One-page workflow (use this every encounter)
1. Confirm POS 31 and payer.
2. Document wound(s): L × W × D (cm), tissue removed, method, undermining/tunneling with clock-face, photos (if allowed). ([HQIN][2])
3. Sum areas by depth (don’t mix depths). ([CMS Downloads][4])
4. Pick service family: selective (97597/-98) vs. excisional depth (11042–11047). ([CMS][5])
5. Code base + add-ons using the 20 cm² rule (“or part thereof”). ([AAPC][6])
6. Consider E/M: If a separate, medically necessary visit occurred (history/exam/MDM beyond the procedure), add E/M with -25. ([CMS][11])
7. Link diagnoses (pressure injury staging, non-pressure ulcer site/severity, diabetes with ulcer, surgical dehiscence/infection) to the procedures per payer LCD. ([CMS][5])
---
### Compliance cautions (common denials)
Missing depth and area in the note → add-ons denied. ([AAPC][12])
Reporting 97597/97598 with 11042–11047 on the same wound. ([CMS][5])
Using E/M without clear, separate work; forget to append -25 when justified. ([CMS][11])
---
Code Description
11000 Dbrdmt ecz/infected skin<10%
11001 Dbrdmt ecz/infct skn ea addl
11004 Dbrdmt skin xtrnl gent&per
11005 Dbrdmt skin abdominal wall
11006 Dbrdmt skin xtrnl gent per
11008 Rmv prstc mtrl/mesh abd wall
11010 Debride skin at fx site
11011 Debride skin musc at fx site
11012 Deb skin bone at fx site
11042 Dbrdmt subq tis 1st 20sqcm/<
11043 Dbrdmt musc&/fsca 1st 20/<
11044 Dbrdmt bone 1st 20 sq cm/<
11045 Dbrdmt subq tiss each addl
11046 Dbrdmt musc&/fsca ea addl
11047 Dbrdmt bone each addl
29580 Strapping unna boot
29581 Apply multlay comprs lwr leg
97597 Dbrdmt opn wnd 1st 20 cm/<
97598 Dbrdmt opn wnd addl 20cm/<
97602 Wound(s) care non-selective
97605 Neg prs wnd ther dme<=50sqcm
97606 Neg prs wnd ther dme>50 sqcm
97607 Neg prs wnd thr ndme<=50sqcm
97608 Neg prs wnd ther ndme>50sqcm
97610 Low frequency non-thermal us
---
Procedure Codes need to be added for Each Wound Treated During this Encounter. Procedure codes will be based on the Procedure performed on that wound and the measurement to create Base Codes and Add-On Codes accordingly. But Each Treated wound must have a procedure.
Assume Place of Service (POS) 31 – Skilled Nursing Facility. ([CMS][1])
---
## Wound Measurement (what to document every time)
Length x Width x Depth (cm): longest head-to-toe length, widest width perpendicular to length, and deepest point for depth. Use the clock-face method to note tunneling/undermining (e.g., “2.5 cm at 3 o’clock”). ([HQIN][2])
Surface area (cm²): Length × Width. Use this to pick base vs. add-on codes. ([Swift][3])
Multiple wounds: add the surface areas of wounds treated to the same depth; don’t combine areas from different depths. ([CMS Downloads][4])
> Tip: Photograph (if policy allows), record drainage/odor, tissue types, signs of infection, and pain—these support medical necessity and code selection.
---
## Picking the right wound service family
1. Selective/active debridement (e.g., biofilm, fibrin, slough removal without cutting into viable tissue) → 97597/97598.
2. Excisional/surgical debridement by depth of tissue actually removed → 11042–11047 (subQ / muscle-fascia / bone).
> Don’t report 97597–97598 with 11042–11047 for the same wound; choose by the deepest tissue removed. ([CMS][5])
---
## CPT breakdown: base vs. add-on (per session)
| Service family | Base code (first 20 cm² or less) | Add-on code(s) (each additional 20 cm² or part thereof) |
| ----------------------------------------- | -------------------------------- | ----------------------------------------------------------- |
| Selective/active debridement | 97597 | +97598 ([AAPC][6]) |
| Excisional debridement – Subcutaneous | 11042 | +11045 ([AAPC][7]) |
| Excisional – Muscle/fascia | 11043 | +11046 ([AAPC][8]) |
| Excisional – Bone | 11044 | +11047 ([AAPC][9]) |
How to count units quickly
Total surface area at the same depth →
If ≤ 20 cm² → bill base only.
If > 20 cm² → bill base + `ceil((total area − 20) / 20)` units of the add-on (because codes allow “or part thereof”). ([AAPC][8])
Example A – selective debridement: Three superficial wounds totaling 38 cm² → 97597 x1 + 97598 x1.
Example B – excisional debridement: SubQ areas totaling 26 cm² → 11042 x1 + 11045 x1. If a separate muscle wound of 12 cm² was also debrided → add 11043 x1 (don’t combine its area with subQ). ([CMS Downloads][4])
---
## Adding the E/M code (when appropriate)
Use Nursing Facility E/M codes when you perform and document a separately identifiable visit in the SNF on the same date as a wound procedure:
Initial NF care: 99304–99306
Subsequent NF care: 99307–99310
Discharge day management: 99315–99316
Select level by 2023 E/M guidelines (MDM or time). If you also perform a debridement, append modifier 25 to the E/M only when the visit is significant and separately identifiable beyond the pre/post-op work of the procedure. ([American Medical Association][10])
Level of MDM Amount and/or Complexity of Data to be Reviewed and
(Based on 2 out of Number and Complexity Analyzed Risk of Complications and/or Morbidity or Mortality of
3 Elements of of Problems Addressed Each unique test, order, or document contributes to the Patient Management
MDM) combination of 2 or combination of 3 in Category 1 below.
Straightforward 99304/99307 Minimal 1 self-limited or minor problem Minimal or none Minimal risk of morbidity from additional diagnostic testing or
treatment
Low 99304 99308 Low 2 or more self-limited or minor problems 1 stable chronic illness 1 acute, uncomplicated illness or injury 1 stable, acute illness 1 acute, uncomplicated illness or injury requiring
hospital inpatient or observation level of care OTC Drugs, PT/OT
Moderate 99305 99309 Moderate 1 or more chronic illnesses with exacerbation, progression, or side effects of treatment 2 or more stable chronic illnesses 1 undiagnosed new problem with uncertain
prognosis 1 acute illness with systemic symptoms 1 acute complicated injury
High 99306 99310 High 1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment 1 acute or chronic illness or injury that poses a threat to life or bodily function
Extensive
---
## Place of Service
Assume POS = 31 (Skilled Nursing Facility) on the claim (as you requested). Note: some payers distinguish NF (POS 32) vs. SNF (POS 31); follow payer policy if told otherwise. ([CMS][1])
---
## One-page workflow (use this every encounter)
1. Confirm POS 31 and payer.
2. Document wound(s): L × W × D (cm), tissue removed, method, undermining/tunneling with clock-face, photos (if allowed). ([HQIN][2])
3. Sum areas by depth (don’t mix depths). ([CMS Downloads][4])
4. Pick service family: selective (97597/-98) vs. excisional depth (11042–11047). ([CMS][5])
5. Code base + add-ons using the 20 cm² rule (“or part thereof”). ([AAPC][6])
6. Consider E/M: If a separate, medically necessary visit occurred (history/exam/MDM beyond the procedure), add E/M with -25. ([CMS][11])
7. Link diagnoses (pressure injury staging, non-pressure ulcer site/severity, diabetes with ulcer, surgical dehiscence/infection) to the procedures per payer LCD. ([CMS][5])
---
### Compliance cautions (common denials)
Missing depth and area in the note → add-ons denied. ([AAPC][12])
Reporting 97597/97598 with 11042–11047 on the same wound. ([CMS][5])
Using E/M without clear, separate work; forget to append -25 when justified. ([CMS][11])
---
Code Description
11000 Dbrdmt ecz/infected skin<10%
11001 Dbrdmt ecz/infct skn ea addl
11004 Dbrdmt skin xtrnl gent&per
11005 Dbrdmt skin abdominal wall
11006 Dbrdmt skin xtrnl gent per
11008 Rmv prstc mtrl/mesh abd wall
11010 Debride skin at fx site
11011 Debride skin musc at fx site
11012 Deb skin bone at fx site
11042 Dbrdmt subq tis 1st 20sqcm/<
11043 Dbrdmt musc&/fsca 1st 20/<
11044 Dbrdmt bone 1st 20 sq cm/<
11045 Dbrdmt subq tiss each addl
11046 Dbrdmt musc&/fsca ea addl
11047 Dbrdmt bone each addl
29580 Strapping unna boot
29581 Apply multlay comprs lwr leg
97597 Dbrdmt opn wnd 1st 20 cm/<
97598 Dbrdmt opn wnd addl 20cm/<
97602 Wound(s) care non-selective
97605 Neg prs wnd ther dme<=50sqcm
97606 Neg prs wnd ther dme>50 sqcm
97607 Neg prs wnd thr ndme<=50sqcm
97608 Neg prs wnd ther ndme>50sqcm
97610 Low frequency non-thermal us
---
Procedure Codes need to be added for Each Wound Treated During this Encounter. Procedure codes will be based on the Procedure performed on that wound and the measurement to create Base Codes and Add-On Codes accordingly. But Each Treated wound must have a procedure.
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Examples:
Medicare, *, *- Applies to all Medicare cases*, Dermatology, *- Applies to all dermatology casesMedicare, Dermatology, California- Most specific rule