How To Use CPT Code 97606

CPT 97606 describes the application of negative pressure wound therapy using durable medical equipment (DME) for wounds with a total surface area greater than 50 square centimeters. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97606?

CPT 97606 can be used to describe the application of negative pressure wound therapy using durable medical equipment (DME) for wounds with a total surface area greater than 50 square centimeters. This code is used when a healthcare provider applies controlled subatmospheric pressure to the wound through a sealed dressing, using a negative pressure therapy system, to aid in the healing process.

2. Official Description

The official description of CPT code 97606 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 greater than 50 square centimeters.’

3. Procedure

1. The healthcare provider assesses the wound and determines the need for negative pressure wound therapy.
2. A foam sponge, matching the size and depth of the wound, is placed over the wound and secured with a transparent film to create a sealed dressing.
3. The provider attaches suction tubing to the dressing through an opening in the film and connects it to a negative pressure therapy pump.
4. The pump creates controlled subatmospheric pressure, removing fluids and infectious materials from the wound and promoting healing.
5. The provider monitors the patient for any signs of distress during the therapy session and ensures the proper functioning of the equipment.
6. Instructions for ongoing care of the wound are provided to the patient or caregiver.

4. Qualifying circumstances

CPT 97606 is used for wounds with a total surface area greater than 50 square centimeters that require negative pressure wound therapy. The healthcare provider must use durable medical equipment (DME) and perform wound assessment and instruction for ongoing care during each therapy session.

5. When to use CPT code 97606

CPT code 97606 should be used when a healthcare provider applies negative pressure wound therapy using durable medical equipment (DME) for wounds with a total surface area greater than 50 square centimeters. It is important to ensure that the therapy session meets the specific criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT 97606, the healthcare provider must document the following information:

• Diagnosis of the wound and the need for negative pressure wound therapy
• Specific details of the therapy session, including the date, start and end time
• Size and depth of the wound
• Details of the sealed dressing and the negative pressure therapy system used
• Observations of the patient during the therapy session
• Instructions provided for ongoing care of the wound
• Signature of the healthcare provider performing the therapy

7. Billing guidelines

When billing for CPT 97606, ensure that the therapy session meets the criteria outlined in the official description of the code. It is important to follow the specific guidelines for reporting this code and to consider any additional tips or requirements provided by the payer. Be aware of any bundling or unbundling issues and use appropriate modifiers if necessary.

8. Historical information

CPT 97606 was added to the Current Procedural Terminology system on January 1, 2005. There have been no updates or changes to the code since its addition.

9. Examples

1. A wound care specialist applying negative pressure wound therapy using durable medical equipment for a patient with a large surgical wound.
2. A nurse performing wound assessment and instructing a patient on ongoing care during a session of negative pressure wound therapy for a diabetic foot ulcer.
3. A physical therapist applying controlled subatmospheric pressure to a burn wound using a negative pressure therapy system.
4. A healthcare provider providing instruction on wound care and ongoing management during a session of negative pressure wound therapy for a patient with a pressure ulcer.
5. A wound care nurse monitoring a patient’s response to negative pressure wound therapy for a complex wound with a total surface area greater than 50 square centimeters.
6. A physician instructing a caregiver on how to perform negative pressure wound therapy for a patient with a chronic non-healing wound.
7. A wound care specialist assessing a patient’s wound and adjusting the negative pressure therapy system during a therapy session.