RE: CPT code 97602 - Non Selective Debridement - covered by Medicare

[Guest guest]

According to the CMS website for our local (CT), 97602 is not reimbursed

separately. It is billed with a modifier with the Whirlpool charge - wp

is covered. It is not covered on its own- considered incidental service.

For the Selective Debridement - whirlpool is included in the code, so

not billed separately.

Kimberley R. Palma

Office Manager - ECHN Rehabilitation Services

Tel: x5579

Fax:

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From: PTManager [mailto:PTManager ] On

Behalf Of Cornwell

Sent: Friday, January 12, 2007 9:19 AM

To: acutept ; 'ptmanager '

Subject: CPT code 97602 - Non Selective Debridement -

covered by Medicare

Just advised by consultants hired to review our charge

master that CPT code 97602 is payable (effective

January 2006). Following is an excerpt from " Code

Correct " with a link to the CMS transmittal. Thought I

would share this info, since I never realized there

was a policy change

Pat Cornwell

Palos Community Hospital

Palos Heights, Il.

Billing for Wound Care Services

Pursuant to a congressional mandate to pay for all

therapy services under one prospective payment system,

CMS created a therapy code list to identify and track

outpatient therapy services paid under the Medicare

Physician Fee Schedule (MFPS). (Balanced Budget Act of

1997, Pub. L. 105-33, Section 1834(k)(5)) CMS provides

this list of therapy codes along with their respective

designations in the Medicare Claims Processing Manual

(Pub. 100-04, Chapter 5, Section 20, at

http://www.cms.hhs.gov/manuals/downloads/clm104c05.pdf

<http://www.cms.hhs.gov/manuals/downloads/clm104c05.pdf>

on the CMS web site).

" Always " versus " Sometimes " Therapy

CMS defines an " always therapy " service as a service

that must be performed by a qualified therapist under

a certified therapy plan of care, and a " sometimes

therapy " service as a service that may be performed by

a non-therapist outside of a certified therapy plan of

care.

Effective January 1, 2006, CMS is reclassifying CPT

codes 97602, 97605, and 97606 as " sometimes therapy "

services that may be appropriately provided either as

therapy or non-therapy services, as well as

maintaining our designation of CPT codes 97597 and

97598 as " sometimes therapy " services. In order to pay

hospitals accurately when delivering these " sometimes

therapy " services independent of a therapy plan of

care, CMS is establishing payment rates for CPT codes

97597, 97598, 97602, 97605, and 97606 under the OPPS

when performed as non-therapy services in the hospital

outpatient setting.

Table 9 below lists the APC assignments and status

indicators for these codes when delivered independent

of a therapy plan of care in a hospital outpatient

setting.

Table 9: CPT Codes for Wound Care Services Paid under

the OPPS Effective for Dates of Service on or after

January 1, 2006

CY 2005 CY 2006

CPT Code Descriptor Therapy Designation Status

Indicator TherapyDesignation APC StatusIndicator

97597 Selectivedebridement (less than or equal to 20

sq. cm.) " Sometimes " therapy A " Sometimes " therapy 0012

T

97598 Selectivedebridement(greater than 20 sq. cm.)

" Sometimes " therapy A " Sometimes " therapy 0013 T

97602 Non-selectivedebridement " Always " therapy A

" Sometimes " therapy 0340 X

97605 Negative pressure wound therapy (less than or

equal to 50 sq. cm.) " Always " therapy A

" Sometimes " therapy 0012 T

97606 Negative pressure wound therapy (greater than 50

sq. cm.) " Always " therapy A " Sometimes " therapy 0013 T

To further clarify, hospitals will receive separate

payment under the OPPS when they bill for wound care

services described by CPT codes 97597, 97598, 97602,

97605, and 97606 that are furnished to hospital

outpatients by non-therapists independent of a therapy

plan of care.

In contrast, when such services are performed by a

qualified therapist under an approved therapy plan of

care, providers should attach an appropriate therapy

modifier (that is, GP for physical therapy, GO for

occupational therapy, and GN for speech-language

pathology) and/or report their charges under a therapy

revenue code (that is, 420, 430, or 440) to receive

payment under the MPFS.

The OCE logic will either assign these services to the

appropriate APC for payment under the OPPS if the

services are non-therapy, or will direct Medicare FIs

to the MPFS established payment rates if the services

are identified on hospital claims with a therapy

modifier or therapy revenue code as therapy.

Pat Cornwell

Dir. of Rehab Services

Palos Community Hospital

Palos Heights, Illinois

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