Billing Problems: CPT Code 97598

on Wednesday, 02 February 2011. All News Items

It has been brought to the attention of MMP, Inc. by one of our clients that Alabama Medicaid is still applying a unit restriction of one (1) for CPT code 97598. The descriptions of CPT codes 97597 and 97598 changed in 2011 – prior to 2011, CPT 97597 was for selective debridement of total wound(s) less than or equal to 20 sq cm and CPT 97598 was for selective debridement of total wound(s) greater than 20 sq cm. In 2011, CPT 97597 is for the first 20 sq cm debrided and CPT 97598 is an add-on code for each additional 20 sq cm, or part thereof, debrided.

MMP, Inc. also notes that the Medicare January 2011 published MUE list also has a quantity of 1 for CPT code 97598 and hospital CCI edits effective for the first quarter of 2011 do not allow the billing of 97597 and 97598 together, even with a modifier. Physician CCI edits have deleted this edit effective December 31, 2010, but since hospital CCI edits are a quarter behind physician edits, this edit change will not be effective for hospitals until April 2011. We have not heard of any problems with Medicare processing of multiple units of CPT 97598 or the billing of CPT 97597 and 97598 for the same date of service, but would appreciate notification if anyone encounters such issues.

Per correspondence to our client facility, Alabama Medicaid recommended holding claims with CPT code 97598 until they are able to address the quantity issue. Due to the above noted Medicaid quantity issue and the Medicare MUE and CCI edits, MMP, Inc. recommends hospital providers, upon administrative approval, consider the option of holding Medicaid and Medicare claims with CPT code 97598 until April 1, 2011.

We will provide further updates on this issue as we become aware of new information.

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