Wound Care CPT Code Reference Card: Print and Post

This is the card you tape to the inside of your laptop lid, pin to the wall above your billing desk, or laminate and tuck into your mobile kit. Twenty codes cover the vast majority of wound care encounters. You'll use some of these daily, others weekly, and a few only for specific clinical scenarios — but when you need them, you need them immediately and you need them right.

For the full code guide with documentation requirements and billing rules, see the complete wound care CPT code guide. For the expanded cheat sheet with modifier details and visit-type organization, see the CPT cheat sheet.

E/M Codes (Evaluation and Management)

These are the bread and butter. Almost every wound care encounter includes an E/M code. MDM (medical decision making) level determines code selection.

Code	Description	MDM Level	Typical Use	Medicare POS 12 Range
99213	Established patient, low	Low	Routine wound check, stable wound, no treatment plan change	~$75-$92
99214	Established patient, moderate	Moderate	Wound with complications, treatment plan adjustment, multiple chronic conditions	~$110-$130
99215	Established patient, high	High	Wound with severe exacerbation, threat to function, high-risk decisions	~$155-$175
99203	New patient, low	Low	New patient, straightforward wound evaluation	~$100-$115
99205	New patient, high	High	New patient, complex wound with multiple comorbidities	~$210-$235

Key rule: When billing an E/M with a procedure on the same day, append modifier -25 to the E/M code. The E/M must document a separately identifiable evaluation beyond the procedure itself. Most wound care visits that include debridement or skin substitute application will bill a 99214-25 alongside the procedure code.

Debridement Codes

Two distinct families based on the depth of tissue removal. Selective debridement removes only nonviable tissue. Excisional debridement involves cutting into viable tissue with active bleeding. The clinical distinction is critical — upcoding selective as excisional is one of the fastest paths to an audit.

Selective Debridement

Code	Description	Surface Area	Medicare POS 12 Range
97597	Selective debridement, first 20 sq cm	<=20 sq cm	~$90-$115
97598	Selective debridement, each additional 20 sq cm	Each add'l 20 sq cm	~$40-$55

Documentation trigger: Document the wound bed before and after debridement. Specify tissue type removed (slough, fibrin, nonviable tissue). Note the instrument used (curette, scissors, forceps). Record the wound area debrided.

Excisional Debridement

Code	Description	Depth	Medicare POS 12 Range
11042	Excisional debridement, skin/subcutaneous	Skin + subcutaneous tissue	~$115-$140
11043	Excisional debridement, muscle/fascia	Through muscle and/or fascia	~$175-$210
11044	Excisional debridement, bone	Through bone	~$230-$280
11045	Each additional 20 sq cm (add-on to 11042)	Skin + subcutaneous tissue	~$45-$60
11046	Each additional 20 sq cm (add-on to 11043)	Through muscle and/or fascia	~$65-$80

Documentation trigger: Document that debridement extended into viable tissue with active bleeding. Specify the depth of tissue removed. Record hemostasis method. Note wound dimensions before and after if debridement altered wound size. Excisional debridement codes require documentation of a separate, distinct decision to debride — they don't bundle with wound assessment.

Skin Substitute Application Codes

These codes are organized by body site and surface area. Getting the area calculation right is everything — the wound measurements in your clinical note must support the code you bill.

Code	Description	Site	Area	Medicare POS 12 Range
15271	Skin substitute graft, trunk/arms/legs, first 25 sq cm	Trunk, arms, legs	First 25 sq cm	~$350-$450
15272	Each additional 25 sq cm (add-on to 15271)	Trunk, arms, legs	Add'l 25 sq cm	~$90-$120
15275	Skin substitute graft, face/scalp/hands/feet, first 25 sq cm	Face, scalp, hands, feet, genitalia	First 25 sq cm	~$400-$500
15276	Each additional 25 sq cm (add-on to 15275)	Face, scalp, hands, feet, genitalia	Add'l 25 sq cm	~$100-$130

Documentation trigger: Document wound bed preparation (debridement if performed). Record exact product name, manufacturer, size used, and lot number. Document the total area of the graft applied in square centimeters. Note that the wound bed was appropriate for graft application (adequate blood supply, clean granulation tissue, absence of active infection). The wound measurements must support the billed area.

Negative Pressure Wound Therapy (NPWT)

Code	Description	Medicare POS 12 Range
97605	NPWT, wound surface area <=50 sq cm	~$90-$115
97606	NPWT, wound surface area >50 sq cm	~$115-$145

Documentation trigger: Document the clinical indication for NPWT (wound type, wound status, why NPWT is the appropriate treatment modality). Record wound dimensions. Specify the NPWT device and settings (pressure level, continuous vs. intermittent). Document that the dressing was applied and the device was functioning at the end of the visit.

Compression and Unna Boot

Code	Description	Medicare POS 12 Range
29580	Unna boot application, below knee	~$50-$70
29581	Multi-layer compression, below knee	~$55-$75

Documentation trigger: Document the vascular assessment supporting compression therapy. ABI >0.8 (or equivalent clinical assessment) must be documented to justify compression. Specify the layers and materials used. Note the clinical indication (venous stasis ulcer, lymphedema, post-operative edema management).

Quick Reference: Modifier Guide

Modifier	Use Case	When to Apply
-25	Significant, separately identifiable E/M	E/M billed same day as procedure
-59	Distinct procedural service	Two procedures on different wounds, same visit
-76	Repeat procedure, same physician	Same procedure repeated same day (rare)
-XE	Separate encounter	Distinct encounter on same date
-LT / -RT	Left side / Right side	Bilateral procedures requiring laterality

Five Rules to Post Next to the Card

Rule 1: Measure before you code. Wound measurements drive code selection for skin substitutes and debridement. If the note says 4.2 x 3.1 cm (13.02 sq cm), you bill 15271 for the first 25 sq cm, not 15272 for additional area. Area math errors are denial magnets.

Rule 2: Selective is not excisional. If the clinician used a curette to remove slough without reaching viable bleeding tissue, that is 97597, not 11042. The reimbursement difference is real. So is the audit risk of billing excisional when the documentation describes selective.

Rule 3: Modifier -25 is not automatic. Attaching -25 to every E/M billed with a procedure invites scrutiny. The E/M documentation must support a separately identifiable evaluation and management service beyond the procedure. A note that says "wound assessed, debridement performed" does not support a separate E/M — the assessment is part of the debridement.

Rule 4: One wound, one debridement code. You do not bill both 97597 and 11042 on the same wound in the same visit. Selective and excisional debridement codes are mutually exclusive per wound. If the debridement was excisional, bill excisional. If it was selective, bill selective. If you debrided two wounds — one selectively and one excisionally — you bill both codes with modifier -59 on the second.

Rule 5: Lot numbers are not optional. Skin substitute claims without product lot numbers are audit failures. The lot number ties the clinical note to the specific product unit dispensed from inventory. If you can't trace the product, you can't defend the claim.

Print this card, laminate it, and keep it within arm's reach. The twenty codes on this page account for the overwhelming majority of wound care revenue. Knowing them cold — not just the code numbers, but the documentation triggers and modifier rules — is the difference between clean claims and preventable denials.