Summary & Overview
CPT 97602: Non-Selective Debridement, Active Wound Care Management
CPT code 97602 represents non-selective debridement procedures, a critical component in wound care management for patients with chronic ulcers, surgical wounds, and other open lesions. This code is widely used in office settings by providers in general practice, family medicine, surgery, and physical therapy. The procedure involves removing devitalized tissue without anesthesia, utilizing methods such as wet-to-moist dressings, enzymatic agents, or abrasion, and includes wound assessment and patient education for ongoing care.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, recognize and reimburse for services billed under CPT code 97602. This publication provides a comprehensive overview of the clinical context, payer coverage, and policy updates relevant to this code. Readers will gain insights into typical use cases, associated diagnoses, and related procedural codes, as well as current benchmarks and trends in reimbursement and utilization. The information is designed to support healthcare professionals, administrators, and policy analysts in understanding the significance of CPT code 97602 within the broader landscape of wound care management.
CPT Code Overview
CPT code 97602 is used to report non-selective debridement procedures performed without anesthesia. This includes methods such as wet-to-moist dressings, enzymatic applications, and abrasion techniques. The service encompasses topical applications, wound assessment, and providing instructions for ongoing care during each session.
The code falls under the Physical Medicine and Rehabilitation – Active Wound Care Management service type and is most commonly performed in an office setting (Place of Service 11). This procedure is essential for managing wounds that require removal of devitalized tissue to promote healing and prevent infection.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with a chronic, non-healing wound, such as a non-pressure ulcer of the lower leg or a pressure ulcer of the buttock. The wound requires non-selective debridement to remove devitalized tissue and promote healing. The provider performs the procedure without anesthesia, using methods such as wet-to-moist dressings, enzymatic agents, or abrasion. The session includes topical applications, wound assessment, and instructions for ongoing care. This service is typically performed in an office setting by providers in general practice, family medicine, surgery, or physical therapy.
Coding Specifications
Modifiers:
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service: Used when a procedure or service is distinct or independent from other services performed on the same day. |
76 | Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by the same provider. |
Provider Taxonomies:
208D00000X– General Practice207Q00000X– Family Medicine208600000X– Surgery225100000X– Physical Therapist
These taxonomies represent the specialties commonly performing active wound care management and debridement procedures.
Related Diagnoses
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L97.909– Non-pressure chronic ulcer of unspecified part of unspecified lower leg- Relevant for patients with chronic ulcers requiring debridement to remove devitalized tissue and promote healing.
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L89.309– Pressure ulcer of unspecified buttock, stage 1- Indicates a pressure ulcer, which may require non-selective debridement as part of wound care management.
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T81.31XA– Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter- Used for patients with surgical wounds that have become disrupted and require debridement.
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S81.009A– Unspecified open wound, unspecified knee, initial encounter- Applies to patients with open wounds of the knee, where debridement is necessary to facilitate healing.
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L98.499– Non-pressure chronic ulcer of skin of other sites with unspecified severity- Covers chronic ulcers at other skin sites, which may benefit from non-selective debridement as described in
97602.
- Covers chronic ulcers at other skin sites, which may benefit from non-selective debridement as described in
Related CPT Codes
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97601: Removal of devitalized tissue from wound(s); selective debridement, without anesthesia (e.g., high-pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.- Used for selective debridement, which targets specific areas of devitalized tissue, as opposed to the non-selective approach in
97602. May be used as an alternative depending on wound characteristics.
- Used for selective debridement, which targets specific areas of devitalized tissue, as opposed to the non-selective approach in
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97597: Selective (including sharp) debridement of devitalized tissue.- Used for selective debridement procedures, often in cases where sharp instruments are used to remove tissue. Can be used in conjunction with
97598for larger wounds.
- Used for selective debridement procedures, often in cases where sharp instruments are used to remove tissue. Can be used in conjunction with
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97598: After debriding the initial 20 cm2 at the same encounter, the provider excises devitalized (dead) tissue from an open wound... use this code for each additional 20 cm2 or part thereof.- Used as an add-on code with
97597for wounds exceeding 20 cm2. Not typically used with97602.
- Used as an add-on code with
These codes are related to wound debridement and may be used as alternatives or in combination, depending on the clinical scenario and wound size.
National Reimbursement Benchmarks
National mean rates for CPT code 97602 show that UnitedHealth Group has the highest average reimbursement at $90.23, while the BUCA (average commercial) mean rate stands at $73.86. Compared to typical Medicare rates, commercial payers generally offer higher mean rates for this procedure.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Cigna exhibits the widest spread at $60.30, indicating significant variability in reimbursement, while Blue Cross Blue Shield and Aetna have tighter ranges of $51.00 and $53.00, respectively. UnitedHealth Group's range is $30.25, the narrowest among the major commercial payers, suggesting more consistent rates.
The table and chart below present a detailed breakdown of national benchmarks for each payer.
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