As a medical coding and prior authorization specialist with more than ten years of experience, I have seen firsthand how errors in billing CPT code 97602 often lead to denials, reduced reimbursement, or compliance risks. This article will guide you through everything you need to know about CPT code 97602, its proper modifier usage, supporting documentation, real-life workflow strategies, and how to avoid costly mistakes. Whether you work in a wound care center, hospital outpatient department, or physician’s office, accurate use of this code plays a vital role in billing non selective wound debridement services.
What Is CPT Code 97602?
CPT code 97602 refers to non selective wound debridement. This includes the removal of devitalized tissue from a wound without the use of anesthesia. The debridement may be performed using techniques such as wet to moist dressings, irrigation, enzyme applications, or gentle mechanical abrasion. Unlike selective debridement procedures, this code does not involve sharp surgical tools or targeted tissue removal.
This code is typically used when treating chronic wounds like pressure ulcers, diabetic foot ulcers, or venous stasis ulcers. The service includes wound assessment, removal of slough or necrotic tissue, topical applications, and instruction to the patient or caregiver.
It is important to understand that this is a bundled code in most physician settings. That means physicians or non physician practitioners are not separately reimbursed for 97602 when performed in the office setting. In contrast, facilities such as hospital outpatient departments or wound care centers may bill this code when the service is provided by qualified personnel under the direction of a provider.
When and How to Use Modifiers with 97602
Correct modifier usage is essential for clarifying the details of a service, distinguishing procedures, and ensuring that the claim is processed properly. Below are the most relevant modifiers used with CPT 97602.
LT and RT Modifiers
When debridement is performed on a wound located on one side of the body, such as the left leg or right foot, the appropriate anatomical modifier should be applied. Use modifier LT for left and RT for right. These modifiers help identify the specific body site involved and are often required by payers to process claims accurately.
If wounds are located on specific digits or toes, digit modifiers (such as F1 through F9 or T1 through T9) may be more appropriate, depending on payer requirements.
Modifier 59
Modifier 59 is used to indicate that a procedure is distinct or separate from another service provided on the same day. This modifier is only appropriate when non selective debridement is performed on a wound that is anatomically separate from another wound receiving a different treatment or procedure. Documentation must support that the wounds are on different body sites and were independently assessed and treated.
This modifier can be used, for example, if whirlpool therapy or selective debridement is also performed on a different wound during the same encounter.
Therapy Modifiers (GP, GO, GN)
CPT 97602 is classified as a “sometimes therapy” code. This means the use of therapy modifiers depends on who performs the service and under what treatment plan. If a physical therapist, occupational therapist, or speech language pathologist performs the procedure under their own therapy plan of care, the service requires a therapy modifier.
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GP is used for physical therapy
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GO for occupational therapy
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GN for speech therapy
If the service is performed under a physician’s treatment plan or as part of incident to services, a therapy modifier is not required.
Documentation Requirements for 97602
One of the most critical elements of billing CPT 97602 is supporting documentation. Without complete and accurate records, the claim is likely to be denied during audits or payer reviews.
Wound Assessment
The documentation should clearly describe the wound’s:
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Location and anatomical site
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Length, width, and depth in centimeters
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Type of tissue present (e.g., necrotic, slough, granulation)
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Presence of infection, drainage, or undermining
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Changes in wound condition compared to prior visits
Debridement Technique
Detail the non selective method used for tissue removal. Examples include:
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Irrigation with normal saline
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Application of enzymatic agents
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Wet to moist dressings
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Soft mechanical abrasion with gauze or pads
Also document the approximate amount or depth of devitalized tissue removed and the provider’s clinical judgment.
Dressing and Patient Education
Any dressing applied is included in the procedure and should be noted in the chart. The same goes for patient or caregiver education related to wound care, dressing changes, and follow up instructions.
Real World Billing Workflow Example
Let’s walk through a typical workflow for CPT 97602 in a wound care facility.
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Initial Assessment: A provider evaluates a patient with a diabetic foot ulcer on the left foot. The wound is measured and found to contain nonviable slough tissue.
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Treatment Plan: The provider orders non selective debridement to be performed by trained facility staff under supervision.
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Procedure: On the same day, facility staff clean the wound, apply an enzymatic agent, and perform gentle mechanical debridement. A sterile dressing is applied.
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Documentation: The wound’s size, condition, tissue types, debridement method, and response to treatment are all recorded. Education is provided on dressing care.
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Claim Submission: The facility bills CPT 97602 with modifier LT to indicate the left foot. No therapy modifier is required since it was performed under the provider’s plan.
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Follow Up: At the next visit, new measurements and tissue type are recorded, and the need for additional debridement is assessed.
This workflow ensures billing accuracy, medical necessity, and proper documentation—all crucial for reimbursement.
Common Billing Mistakes and How to Avoid Them
Reporting Multiple Debridement Codes
Only one debridement code should be billed per wound per session. If both selective and non selective debridement techniques are attempted, code the highest level of service performed. Never bill 97602 alongside codes for selective debridement (97597 or 97598) or surgical debridement (11042–11047) on the same wound for the same date.
Billing for Dressing Changes Only
Dressing changes alone do not qualify for CPT 97602. The service must involve actual removal of devitalized tissue using non selective methods.
Failing to Use Modifiers
Omitting anatomical modifiers like LT or RT can result in claim denials or reduced payments. The same applies to modifier 59 when multiple procedures are performed on different wounds.
Missing Therapy Modifiers
When therapists perform debridement under their own treatment plan, failure to include the correct therapy modifier (GP, GO, GN) can result in denials for lack of medical necessity or incorrect billing.
Frequently Asked Questions
Can CPT 97602 be billed by a physician?
In most cases, no. This code has a bundled status under the physician fee schedule, meaning it is not separately payable when performed in the office. However, facilities can bill for it when performed by qualified personnel.
How often can 97602 be billed?
It can be billed as frequently as medically necessary, as long as each session is fully documented and shows a need for continued debridement. Repetitive billing without wound improvement may raise red flags.
Can 97602 be billed with an E/M code?
Yes, but only if a separately identifiable evaluation and management service was performed and documented. Modifier 25 must be appended to the E/M code to indicate that it is distinct from the wound care service.
Is photo documentation required?
It is not mandatory, but photo documentation can strengthen the medical record, especially in cases involving repeated debridement or denials.
Do insurance rules vary by payer?
Yes. Always verify each payer’s coverage and billing policy for wound care services. While Medicare rules are widely followed, private payers may have additional requirements.
Conclusion
CPT code 97602 is an essential part of wound care billing, especially in facility-based settings. Correct use of modifiers such as LT, RT, 59, and the appropriate therapy modifier ensures clarity and compliance. Proper documentation, accurate coding, and structured workflows form the foundation of successful reimbursement and audit readiness.
By mastering the nuances of 97602 and its modifiers, you can prevent claim denials, improve revenue integrity, and ensure the best care for patients requiring wound management. For coders and billing teams alike, attention to detail and understanding payer-specific nuances will always be the key to success.