Monitor Method, Size, and Depth When Selecting Debridement Codes
Remember add-on codes when additional surface area is addressed. When patients come to the emergency department (ED) with wounds that aren’t healing properly or that need to be cleaned, your physician may perform debridement. During this procedure, the provider removes damaged or dead tissue from the wound to help it heal and prevent infection. Read on to learn the steps you’ll need to follow so you can select the right debridement code in every situation. Surgical Debridement? Consider 11000 Range Doctors in the ED may perform several different types of debridement. The first is called surgical debridement. These procedures are used to take dying or dead tissue away from the wound to promote healing. When you navigate to the CPT® codes for surgical debridement, you’ll see quite a few options in the 11000-+11047 range. The following codes represent excisional procedures, involving the removal of abnormal tissue such as eschar, slough, granulation, or necrosis to reach viable tissue: Each of the four sections above includes a primary code (for instance, 11000, which describes the first 10 percent of the body surface) and an add-on code (such as +11001, which describes each additional 10 percent). In the case of 11042, 11043, and 11044, these primary codes describe the first 20 square centimeters (sq cm) treated, while +11045, +11046, and +11047 describe each additional 20 sq cm. Calculate: If your provider addresses wounds of the same depth but on different anatomic sites, you should add the total surface area together and code based on that total surface area. But you shouldn’t add the area of multiple wound debridements at different depths together. Instead, report the appropriate code(s) from each depth family. For example: Suppose a patient presents with two infected wounds including necrotized tissue down to the muscle. After addressing 20 sq cm at the muscle depth on the left elbow and another 20 sq cm at the muscle depth on the right elbow, the physician reports 11043 (… first 20 sq cm or less) and +11046 (… each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)). But if the physician debrides 20 sq cm at the muscle layer on the left elbow and 20 sq cm at the bone layer on the right elbow, you’d report 11043 and 11044 (… first 20 sq cm or less). Because the National Correct Coding Initiative (NCCI) bundles 11043 into 11044, you’ll need to append modifier 59 (Distinct procedural service) to 11043 to collect for both services. Documentation tip: Many payers will request documentation to support the use of 11044 if you submit that code. For that reason, the Centers for Medicare & Medicaid Services (CMS) advises, “Submitting documentation substantiating depth of debridement when billing the debridement procedure described by CPT® code 11044 is encouraged.” By submitting it along with your initial claim, you’ll save time later and reduce the odds of getting your claims denied. Consider 97000 Series for Active Wound Care Management Not every debridement your ED physician performs will require the surgical debridement codes. In other cases, the provider may perform active wound care management. This service involves debriding areas of devitalized tissue using such modes as sharp excision, high-pressure waterjet, or nonselective processes such as abrasion or enzyme treatments. You’ll report these procedures using codes such as the following: Although the ED provider’s work may be similar for some wound debridement codes as active wound care management, don’t get confused between the two groups of codes. Key: Active wound care management involves epidermis and dermis only. On the other hand, the wound debridement codes 11042-+11047 all involve deeper layers. That’s why CPT® text notes in the Debridement section read “for debridement of skin [ie, epidermis and/or dermis only], see 97597, +97598.” In addition, you can’t mix and match code families when you only address one wound. CMS reports in its reference article, “Code(s) 97597, 97598 and 97602 should not be reported in conjunction with code(s) 11042-11047 for the same wound. The wound depth debrided determines the appropriate code.” Get to Know Other Debridement Types Your ED physician may perform other types of debridement that don’t fall under the codes listed above. CPT® provides specific codes in certain other conditions. Check out the examples below for guidance about how to report a few other debridement methods. Nail debridement: Suppose a patient presents to the ED with a fungal infection affecting the third and fourth toes of their left foot. The ED provider debrides both nails and reports 11720 (Debridement of nail(s) by any method(s); 1 to 5). Because the code descriptor includes up to five nails and your doctor only debrided two of them, there’s no need to report any additional codes. You’re advised to report the appropriate toe modifiers if possible, which in this case would be T2 (Left foot, third digit) and T3 (Left foot, fourth digit). Burn debridement: Let’s say a patient presents to the ED with a second-degree burn affecting less than 5 percent of the total body surface area (TBSA). The ED provider debrides and dresses the burn. For this service, you’ll report 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area). Torrey Kim, Contributing Writer, Raleigh, North Carolina
