Wound care coding is a precision sport. Clean payment hinges on matching clinical intent to the right code family, stating the deepest tissue actually treated, showing the square-centimeter math, and documenting device or product details when they matter.
Most denials aren’t exotic; they’re tiny gaps: “exposed” instead of “excised,” missing add-on area, no device type for negative pressure, or a skin substitute line without product specifics or the paired application code.
This guide closes those gaps with a focused list of everyday CPT codes and the exact documentation cues reviewers expect, so clinical notes, coding, and billing move in sync.
Selective or active debridement
Selective debridement applies when devitalized tissue is removed without cutting into viable tissue. Code selection is primarily driven by total surface area.
Codes to know
- 97597 for the first 20 square centimeters or less
- 97598 for each additional 20 square centimeters
Documentation that protects payment
- Identify the instrument or method such as curette, scissors, scalpel, forceps, or waterjet
- Show pre and post measurements in centimeters
- State the tissue type removed and the clinical reason the removal was skilled
- Keep the area calculation visible so the initial unit and any additional units are obvious
Common mistakes to avoid
- Calling an encounter selective when the description actually reflects excision into viable tissue
- Omitting instrument and size details, which creates uncertainty for medical review
Excisional debridement by depth
Excisional debridement is chosen by the deepest level of viable tissue actually removed in that anatomic site. Add units for additional surface area beyond the base descriptor. Do not code to what was only exposed.
Codes to know
- 11042 subcutaneous tissue and +11045 for each additional 20 square centimeters
- 11043 muscle or fascia and +11046 for each additional 20 square centimeters
- 11044 bone and +11047 for each additional 20 square centimeters
Documentation that protects payment
- Name the instrument such as scalpel or rongeur
- Record anesthesia and hemostasis where appropriate
- Show post-debridement length, width, and depth in centimeters
- Tie the rationale for excision to diagnosis and skilled need
Common mistakes to avoid
- Coding to exposed depth rather than excised depth
- Forgetting the add-on unit when size exceeds the base 20 square centimeters
- Blending multiple sites into a single narrative without site-specific depth and size
Practical selection logic – If subcutaneous tissue is excised over 28 square centimeters, report 11042 plus +11045 for the additional eight square centimeters. If bone is removed across 22 square centimeters, report 11044 only, because the area does not reach the threshold for +11047.
Extensive infected or eczematous skin by body surface
When the service addresses widespread infected or eczematous skin rather than discrete ulcers, selection shifts to percent body surface area. These codes are not for focal ulcers.
Codes to know
- 11000 up to 10 percent body surface area
- +11001 each additional 10 percent body surface area or part thereof
Documentation that protects payment
- State the clinical indication for extensive debridement
- Record the percentage of body surface treated and where it is distributed
- Distinguish this work from ulcer-directed debridement on the same date
Negative pressure wound therapy
Negative pressure coding hinges on device type and total treated area across all wounds in the session. Pick the family first by technology, then select by area.
DME pump systems
- 97605 for 50 square centimeters or less
- 97606 for more than 50 square centimeters
Disposable systems
- 97607 for 50 square centimeters or less
- 97608 for more than 50 square centimeters
Documentation that protects payment
- State the device type clearly as durable pump or disposable system
- Record total treated area across all wounds that day
- Include device settings and a brief note of assessment and patient instructions if required by policy
- Clarify if the disposable system is newly applied or replaced with a new device
Common mistakes to avoid
- Mixing the two families based on habit rather than device type
- Forgetting to total the area across multiple wounds before choosing the size tier
- Omitting settings and device type, which sends the claim to review
Practical selection logic – If disposable negative pressure is applied to two wounds totaling 60 square centimeters, report 97608. If a durable pump is managed for 35 square centimeters, report 97605.
Skin substitute grafts and cellular or tissue based products
Application codes depend on body region and size tier. The product itself is generally reported with HCPCS according to payer policy. The clinical note must identify the product, units, and wastage.
Trunk, arms, legs
- 15271 initial wound small size tier
- +15272 each additional wound small size tier
- 15273 initial wound large size tier
- +15274 each additional wound large size tier
Face, scalp, eyelids, mouth, neck, ears, nose, lips, genitalia, hands, feet, multiple digits
- 15275 initial wound small size tier
- +15276 each additional wound small size tier
- 15277 initial wound large size tier
- +15278 each additional wound large size tier
Documentation that protects payment
- Record per wound dimensions and the anatomic site
- List product name and quantity, lot number if required, and fixation method
- Document wastage explicitly, including amount and reason
- Pair the product line with the application CPT on the same claim as policy requires
Common mistakes to avoid
- Reporting a product without an application code
- Using a not otherwise specified product code without including the product name and invoice details
- Collapsing multiple wounds into a single size figure that cannot be reconciled to the units billed
Practical selection logic – Application to a venous ulcer on the leg is typically 15271 for the initial wound, with the product billed separately. If a second leg wound is treated in the same session within the same size tier, add +15272.
Adjacent services seen with wound care
These codes are not debridement or application but are commonly seen around wound encounters when medically necessary and properly documented. Always check NCCI edits before reporting them separately.
- 97610 low frequency non contact non thermal ultrasound wound therapy per session
- 29581 multilayer compression system leg below knee
- 29582 through 29584 multilayer compression for thigh and leg or upper extremity as applicable
- 29580 strapping of lower extremity
- 13160 secondary closure of extensive wound dehiscence
- 12020 treatment of superficial wound dehiscence simple closure
- 12021 treatment of superficial wound dehiscence with packing
- 96372 therapeutic or prophylactic injection subcutaneous or intramuscular
- 10060 through 10061 incision and drainage of abscess simple versus complicated
- 15002 through 15005 surgical preparation of recipient site prior to graft or cellular or tissue based product
Modifier control and NCCI awareness
Modifiers are signals that change how edits are applied. They must be supported by the record. Use 59 or the X modifiers only when procedures are distinct by site or service and current edits allow separate reporting. Use 25 only when a significant and separately identifiable evaluation and management service occurred beyond the inherent pre and post work of the procedure.
Apply laterality or bilateral modifiers such as RT, LT, and 50 when policy requires them and when the note clearly shows the anatomy. A short pre-submission check against current PTP edits prevents a large share of bundling-related denials. For Medicare, tie every code to the applicable NCD/LCD, show medical necessity, use required modifiers, and honor frequency/coverage edits.
Documentation checklist for coders and clinicians
Before coding or submitting, confirm these items are present and match the lines you plan to bill.
- Exact site for each wound treated
- Pre and post measurements in centimeters and the deepest tissue actually removed when excisional work is performed
- Instrument or method used for debridement
- Anesthesia and hemostasis details when surgical
- Area math that supports each add-on unit for 11045, 11046, 11047, or 97598
- Device type for negative pressure and total treated area across all wounds
- Product name, quantity, fixation, and wastage for skin substitutes and the paired application code on the same claim
- Clear separation of work at distinct sites if a modifier is planned
- Alignment of diagnosis codes with the procedures reported
Denial traps and fast fixes
Trap 1: Coding to exposed tissue rather than excised tissue in the excisional family
Fix: Anchor selection to the deepest layer actually removed and name the instrument that performed the removal
Trap 2: Missing or unclear surface area math for add-on units
Fix: Keep the calculation visible in the note so reviewers can match units to area increments
Trap 3: Wrong negative pressure family
Fix: Pick by device type first. Durable pump uses 97605 or 97606. Disposable system uses 97607 or 97608
Trap 4: Skin substitute lines that lack product specifics or omit the application CPT
Fix: Include product name and quantity and ensure 15271 through 15278 appear as appropriate
Trap 5: Overuse of 59 or 25
Fix: Verify current edits. Document distinct site or significant evaluation and management only when those elements truly occurred
