Widespread Probe Notification of CPT Codes 97597 and 97598
The following information applies to Medicare providers who submit claims to the Cahaba office in Des Moines, Iowa
As a result of Part A Medical Review data analysis, a widespread prepay probe review will be conducted of CPT code 97597 Wound Debridement; Total Wound(s) Surface Area <or = 20 Square Centimeters and CPT code 97598 for Wound Debridement; Total Wound(s) Surface> 20 Square Centimeters for all bill types. The topic for this review will be 5141W. Claims meeting the parameters of this edit will be selected across the provider community. Once selected, the claims will be reviewed for medical necessity (e.g., compliance with CMS guidelines, contractor local coverage determinations (LCDs), correct billing and coding). This will be a line level review. In addition to reviewing CPT codes 97597 and 97598, all evaluation and management (E/M) codes billed on the same date of service as CPT codes 97597 and 97598 will be reviewed. The data from this review will assist us in determining the educational needs for providers. Once completed, the results of this probe will be posted on the What’s New from Cahaba page of our Web site.
Page last updated: Oct. 31, 2007
