Wound Care Billing Services —
Debridement, HBO & All Wound Care Codes

Debridement code selection requires three pieces of information from the wound assessment note: (1) Is the wound open (exposed subcutaneous tissue, muscle, or bone visible) or non-open (intact epithelium over the wound bed)? Open wounds use 97597/97598; non-open wounds use the 11042/11043/11044 series. (2) What is the deepest tissue level debrided? Skin = 97597 or 11042; subcutaneous tissue = 97597 or 11042; muscle/fascia = 97597 or 11043; bone = 97597 or 11044. (3) How large is the wound in square centimeters? The first code covers the first 20 sq cm; add-on codes (97598 for open, 11045/11046 for the 110xx series) add billing units for each additional 20 sq cm. The correct code comes from the documented wound measurement and depth assessment — not from a standard charge entry default.

Skin substitute billing requires three tiers of documentation: (1) Clinical documentation — wound size measured in sq cm, wound preparation performed before application, the product name and lot number applied, the amount used vs. the amount available in the package, and the physician's clinical assessment; (2) Invoice documentation — distributor invoice showing product name, lot number, quantity, and acquisition cost. Medicare requires that the amount billed reflects actual acquisition cost or the fee schedule amount, whichever is lower; (3) Authorization documentation — some payers require pre-authorization for skin substitutes, particularly for newer or higher-cost products. We collect all three documentation tiers before submitting any skin substitute claim.

Medicare covers HBO for the following wound indications: diabetic wounds of the lower extremities (Wagner Grade 3 or higher) that have not shown measurable signs of improvement within 30 days of standard wound care; chronic osteomyelitis (bone infection) that has failed standard antibiotic treatment; radiation tissue damage (osteoradionecrosis and soft tissue radionecrosis from therapeutic radiation); preparation and preservation of compromised skin grafts and flaps; acute peripheral arterial insufficiency; gas gangrene and other progressive necrotizing infections. Coverage requires both the correct diagnosis and documentation of failed standard treatment before HBO. Commercial coverage largely mirrors Medicare criteria with some variation.

Hospital outpatient wound care centers bill through the hospital's outpatient facility system using APC (Ambulatory Payment Classification) reimbursement for the facility component, with the physician billing professional fees separately. Physician office-based wound practices bill professional fees directly, with the practice billing both professional and any applicable supply/device codes directly. The key difference: hospital outpatient patients encounter cost-sharing under their outpatient hospital benefit (typically 20% of APC rate), while office-based wound care patients encounter their outpatient professional fee cost-sharing. We configure billing for both settings and coordinate professional fee billing whether your wound physicians work in a hospital setting or an independent office.

Yes. Surgical skin grafting generates different codes than bioengineered skin substitute application: split-thickness skin graft (STSG: 15100 for first 100 sq cm, 15101 for additional units), full-thickness skin graft (FTSG: 15200/15201 by anatomical location and size), and donor site management codes. When the same practice both applies bioengineered substitutes (Q-codes) and performs surgical grafting (15100 series), we manage both billing streams. Skin grafts require separate prior authorization from most commercial payers and have specific documentation requirements: wound chronicity, wound measurements, and documentation of failure of less-invasive wound care.

NPWT generates two separate billing streams: the device placement code — 97605 for wounds 50 sq cm or less, 97606 for wounds larger than 50 sq cm — and ongoing supply billing for the dressings, canisters, and tubing, billed as DME through the applicable HCPCS codes. When the physician office provides the NPWT service directly, both the procedure code and the supply codes are billable from the office. When a separate DME company supplies the pump, the supply billing runs through that DME company instead, and we bill only the procedure code from the office side. We verify which arrangement applies before configuring the claim.

Each wound is measured and coded from its own documentation, and the total area across all wounds determines the total billable units — not just the largest or first wound treated. For example, three wounds debrided in one session at 15, 12, and 8 sq cm total 35 sq cm: the correct billing is 97597 for the first 20 sq cm (covering the first wound) plus one unit of 97598 for the additional 15 sq cm from the remaining wounds. Billing only for the first wound and leaving the others off the claim under-bills the actual debridement work performed. We review the session note for the number of wounds treated and each wound's individual measurement, then apply the primary-plus-add-on structure to the combined total.