Some call it intentional, others call it Murphy's law, but I tend to call it the law of unintended consequences.  As a software developer, I am intimately aware that any time you intervene in a complex system you have the opportunity to create an unanticipated and sometimes undesirable outcome.

At Intellicure, we've spent months getting ready for some dramatic changes to debridement coding.  For a quick refresher, the AMA has dispensed with the system of coding multiple surgical debridements as multiple independent procedures and replaced it with a system of adding the surface areas of the multiple sites and then using a series of primary and add-on codes to reflect the total surface area debrided.  Our Chief Medical Officer, Dr. Caroline Fife has done a great job of describing these changes using a series of real world examples to illustrate the new process using a series of slides and webinars (available to Intellicure clients).

We recently noticed that CMS' Medically Unlikely Edits (MUE) have not been updated to reflect the new code instructions for CPT 97598, and still list it with a quantity of “1”.  We've begun making inquiries to certain Medicare contractors, but at the time of this writing correctly coded claims are going to get rejected presuming they have a quantity of more than "1" which would of course occur when you debride a wound (or wounds) with a collective surface area that measures more than 40 sq. cm.We are also going to be following CMS' guidance to get a MUE updated so this may all be resolved when the second quarter NCCI/OCE edits are released in April. Until then, for the answer of how to report the any extra 97598s, I suggest that providers contact their pertinent Medicare medical directors, explain the issue, and ask how their particular system will process the claims.  Until CMS changes the MUEs, the Medicare contractors will have to program their computers to accept additional units of this code, which will probably be done by modifier which they'll have to share.