What Is CPT Code 97598? Wound Care Billing Explained

When it comes to wound care, precision in coding directly impacts reimbursement and compliance. CPT code 97598 plays an important role in medical billing for selective wound debridement procedures, especially when multiple or large wounds are involved.

At Express Medical Billing, we work with healthcare providers every day to ensure clean claims and faster payments, and proper coding of 97598 CPT code is a key part of that.

Understand CPT Code 97598

CPT code 97598 is defined as:

“Selective debridement of open wounds may involve tools like a scalpel, scissors, forceps, or high-pressure waterjet systems (with or without suction). This procedure addresses devitalized tissues such as fibrin, slough, biofilm, and other debris. It also includes topical treatments, wound evaluation, whirlpool therapy (if applicable), and follow-up care guidance. This applies to each additional 20 square centimeters beyond the initial area.”

In simple terms, it covers each additional 20 cm² outside what is included in CPT 97597, which accounts for the first 20 cm² of selective debridement. This means 97598 CPT code is an add-on code and must be billed with 97597 to be valid.

CPT 97597 and 97598 - What's the Difference?

Both codes are used for selective debridement — the process of removing devitalized or necrotic tissue to promote wound healing. However:

CPT code 97597 is used to bill for the first 20 square centimeters of wound debridement performed using selective techniques.

CPT code 97598 should be reported for every extra 20 square centimeters of debrided tissue after the first 20 cm².

For example, if a provider treats a wound that measures 40 cm², they would bill 97597 for the first 20 cm² and 97598 once for the next 20 cm².

When to Use CPT Code 97598

Use 97598 CPT code when:

The wound area exceeds 20 cm²
This type of debridement involves the use of sharp surgical tools, such as a scalpel or scissors, to remove unhealthy tissue.
There is clinical justification and detailed documentation
It is performed in conjunction with 97597

Pro Tip: Always include accurate wound measurements and instrument details in your chart notes. This supports proper medical billing and helps avoid denials.

Is CPT 97598 an Add-On Code?

Yes, 97598 is an add-on code and cannot be reported alone. It is only reimbursable when billed with CPT 97597.

Example:
A patient has a 55 cm² wound. The billing would include:

97597 x 1 (for first 20 cm²)
97598 x 2 (for additional 40 cm², divided into two units)

CPT Code 97598 Modifier Usage

Modifiers play a key role in maximizing reimbursement while staying compliant. Commonly used ones with 97598 CPT codes include:

Modifier -59: Indicates a distinct procedural service, especially when billed with CPT 11042 or other debridement codes.
Modifier -25: If billed on the same day as an E/M service, this modifier shows that the procedure was separately identifiable.

Important: Modifier misuse is a top reason for denials. Accurate documentation is your strongest defense.

CPT Code 97598 Reimbursement

Reimbursement for 97598 CPT code varies depending on payer, place of service, and whether the provider is in-network. Medicare and most private insurers will reimburse this code only if:

Proper documentation supports the additional wound area treated
The code is billed as an add-on to 97597
The procedure is medically necessary

For instance, Medicare 2025 payment rates (subject to locality) may reimburse CPT 97598 between $28–$40 per additional unit, but rates change annually. Always verify with your local MAC or commercial payer fee schedule.

Related Wound Care CPT Codes

In wound care billing, it’s critical to understand how 97598 CPT code interacts with other codes:

CPT 97597 –Use CPT 97597 for the initial 20 cm² of selective sharp debridement of a wound.
CPT 11042 – CPT code 11042 refers to non-selective debridement that targets the skin and underlying subcutaneous layer.
Ulcer debridement CPT code – Depends on depth and method (e.g., 11043, 11044)
66680 CPT code – Eye-related procedures, often unrelated but sometimes confused
43753 CPT code – Nasogastric tube placement
27652 CPT code – Tendon repair (unrelated but often mixed up in searches)

Before assigning a CPT code, carefully evaluate the depth of the wound and the method used for debridement. Selective vs non-selective makes a big billing difference.

First-Hand Insight from Billing Experts

At Express Medical Billing, we’ve helped countless providers correct denied claims where 97598 CPT code was either under billed or misused. Here’s a real-world case:

A podiatrist submitted 97597 only for a diabetic foot ulcer measuring 38 cm². The claim was underpaid, and 97598 were missing. After resubmitting with 97597 + 97598, the claim was processed in full, adding $35 in additional reimbursement for less than 5 minutes of documentation work.

This proves how attention to detail in wound measurements and code usage can translate directly to better cash flow.

Conclusion

Wound care billing isn’t just about the procedure, it’s about accurate coding, documentation, and compliance. CPT 97598 is more than just an add-on; it’s an opportunity to capture the full scope of services provided and ensure your practice gets paid what it deserves.

If you’re unsure whether you’re coding 97598 CPT code correctly, don’t leave money on the table. Partner with Express Medical Billing to eliminate guesswork and accelerate your revenue cycle.

Learn more about our Medical Coding Services and how we help providers optimize wound care billing.

Frequently Asked Questions (FAQs)

What does CPT code 97598 mean?

It represents selective sharp debridement for each additional 20 cm² of a wound beyond the initial 20 cm² covered by 97597.

Is CPT 97598 a standalone code?

No. It must be billed with CPT 97597 and is considered an add-on code.

Can you bill CPT 97598 with CPT 11042?

Yes, but only when procedures are distinct and well-documented, use modifier -59 to show this.

What is the CPT code for spiral care debridement?

It depends on the method and depth. For selective sharp debridement, use 97597 and 97598.

How do I know when to use 97598?

Use this when the wound surface area is greater than 20 cm² and selective debridement is performed using sharp instruments.

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What Is CPT Code 97598? Wound Care Billing Explained

Understand CPT Code 97598