How To Use CPT Code 97605

CPT 97605 refers to negative pressure wound therapy for wounds with a total surface area less than or equal to 50 square centimeters. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 97605.

1. What is CPT 97605?

CPT 97605 is a medical billing code used to describe negative pressure wound therapy (NPWT) for wounds with a total surface area less than or equal to 50 square centimeters. This therapy involves the application of controlled subatmospheric pressure to the wound using durable medical equipment (DME) to promote healing and remove fluids and infectious materials.

2. 97605 CPT code description

The official description of CPT code 97605 is: “Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), 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 square centimeters.”

3. Procedure

1. The provider cleans and checks the wound for the absence of sinus tracts and fistulas.
2. A foam sponge, sized and shaped to fit the wound, is applied over the wound.
3. A transparent film is used to cover the sponge and create a rigid seal.
4. Suction tubing is inserted into the dressing through an opening in the transparent film.
5. The tubing is connected to a negative pressure therapy pump.
6. The pump is activated, and the provider monitors the patient for signs of distress and ensures proper functioning of the equipment.
7. The provider instructs the patient or caregiver on how to provide care for the wound.

4. Qualifying circumstances

Patients eligible to receive CPT code 97605 services are those with wounds that have a total surface area less than or equal to 50 square centimeters and require negative pressure wound therapy for healing. These wounds may be acute or chronic, and the therapy may be necessary due to factors such as infection, poor circulation, or other underlying medical conditions that impede the healing process.

5. When to use CPT code 97605

It is appropriate to bill the 97605 CPT code when a patient requires negative pressure wound therapy for a wound with a total surface area less than or equal to 50 square centimeters. This code should be used for each session of therapy, which includes the application of the therapy, wound assessment, and instructions for ongoing care.

6. Documentation requirements

To support a claim for CPT 97605, the following information should be documented:

• Patient’s medical history and relevant underlying conditions
• Wound assessment, including size, depth, and presence of infection or other complications
• Details of the negative pressure wound therapy procedure, including equipment used and settings
• Instructions provided to the patient or caregiver for ongoing care
• Progress notes and follow-up assessments to track the healing process

7. Billing guidelines

When billing for CPT code 97605, it is important to follow the appropriate guidelines and rules. This includes ensuring that the therapy is medically necessary and supported by documentation. Additionally, the code should be billed per session, and separate billing for post-operative care is allowed as it is not part of the global care package.

8. Historical information

CPT 97605 was added to the Current Procedural Terminology system on January 1, 2005. The code was updated on January 1, 2015, with the previous descriptor being “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 square centimeters.”

9. Similar codes to CPT 97605

Five similar codes to CPT 97605 and how they differ are:

1. CPT 97606: This code is used for negative pressure wound therapy for wounds with a total surface area greater than 50 square centimeters.
2. CPT 97597: This code is for selective debridement of a wound without anesthesia, including the removal of devitalized tissue, slough, or foreign material.
3. CPT 97598: This code is for additional selective debridement of a wound, per square centimeter.
4. CPT 97602: This code is for non-selective debridement of a wound, including the removal of devitalized tissue, slough, or foreign material.
5. CPT 97607: This code is for negative pressure wound therapy with disposable, non-durable medical equipment for wounds with a total surface area less than or equal to 50 square centimeters.

10. Examples

1. A patient with a diabetic foot ulcer measuring 40 square centimeters requires negative pressure wound therapy to promote healing.
2. A patient with a post-surgical wound infection measuring 30 square centimeters requires negative pressure wound therapy to remove infectious materials and promote healing.
3. A patient with a pressure ulcer measuring 50 square centimeters requires negative pressure wound therapy to remove necrotic tissue and promote healing.
4. A patient with a venous leg ulcer measuring 45 square centimeters requires negative pressure wound therapy to improve circulation and promote healing.
5. A patient with a traumatic wound measuring 35 square centimeters requires negative pressure wound therapy to remove debris and promote healing.
6. A patient with a burn wound measuring 25 square centimeters requires negative pressure wound therapy to remove dead tissue and promote healing.
7. A patient with a non-healing surgical wound measuring 20 square centimeters requires negative pressure wound therapy to promote healing.
8. A patient with a chronic wound measuring 15 square centimeters requires negative pressure wound therapy to remove slough and promote healing.
9. A patient with a skin graft measuring 10 square centimeters requires negative pressure wound therapy to promote graft adherence and healing.
10. A patient with a complex wound measuring 5 square centimeters requires negative pressure wound therapy to remove foreign material and promote healing.