Basics about Wound Debridement CPT codes
Debridement of wound are divided into three types, Excisional, Selective and Non-selective. We are going to learn about excisional debridement first. A sharp removal of viable tissue from the wound margin or at the wound base is called as excisional debridement. The CPT codes ranging from 11042 to 11047 are used for coding excisional debridement. These codes are categorize of the basis of the deepest layer viable tissue being removed. Let us first checkout the types of debridement.
Excisional — Surgical removal of tissue (i.e., necrosis, eschar, slough, infected tissue, abnormal granulation tissue) at the wound margin or at the wound base until viable tissue achieved.
Selective — The removal of specific targeted areas of non-viable tissue or viable tissue that may be intermingled with non-viable tissue, which limits healing from a wound along the margin of the viable tissue.
Nonselective — Nonsurgical debridement by brushing, irrigation, scrubbing, or washing of devitalized tissue, necrosis, or slough (i.e., whirlpool therapy, medicated dressings, pulse lavage).
Debridement involving Subcutaneous Tissue
11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) first 20 sq cm or less
+11045 each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
Debridement Involving Muscle and/or Fascia
11043 Debridement, muscle and/or fascia (includes epidermis and dermis and subcutaneous tissue, if performed); first 20 sq cm or less
+11046 each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
Debridement Involving Bone
11044 Debridement, bone, (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
+11047 each additional 20 sq cm, or part thereof
Supply codes used with CPT code 11042, 11043 and 11045
SG079 tape, surgical paper 1in (Micropore)
SH069 sodium chloride 0.9% irrigation (500-1000ml uou)
SJ009 basin, irrigation
SL033 culture swab system (Culturette)
SA043 pack, cleaning, surgical instruments
SA048 pack, minimum multi-specialty visit
SB007 drape, sterile barrier 16in x 29in
SB011 drape, sterile, fenestrated 16in x 29in
SB012 drape, sterile, for Mayo stand
SB024 gloves, sterile
SB027 gown, staff, impervious
SB042 towel, non-sterile
SB044 underpad 2ft x 3ft (Chux)
SC056 syringe 50-60ml
SF007 blade, surgical (Bard-Parker)
SG018 bandage, Kling, non-sterile 3in
SG035 dressing, 3in x 4in (Telfa, Release)
SG052 gauze, self-adherent roll 0.5in to 2in (Fabco, Gauztex)
SG056 gauze, sterile 4in x 4in (10 pack uou)
SH069 sodium chloride 0.9% irrigation (500-1000ml uou)
Point to remember while coding Wound Debridement CPT codes
Integumentry system CPT codes are little tough to understand. If you know about wound repair codes for simple, intermediate and complex, they also take little more time to understand. Here, also for wound debridement CPT codes we have to follow few ICD 10 coding rules and guidelines for coding these procedure codes. Mainly below points should be followed while coding CPT codes 11042, 11043, 10145 etc. To code an Excisional debridement CPT codes the provide document must include
Wound size by depth, length or depth
Removal of viable tissue
Bleeding tissue
When multiple wounds are debrided all to the same depth, combine the debrided surface measurements to arrive at the appropriate code(s). Calculate the total surface area of each wound debride and code accordingly.
For example, when a provider debrides 25 sq cm of subcutaneous tissue from the right leg, and 20 sq cm of subcutaneous tissue from the left leg. Now, here the wound debride is from the same depth, that is subcutaneous tissue, hence we can combine the total surface(25+20=45) of both leg and code appropriately. The correct CPT for the example will be 11042 and 11045×2.
Rationale: For first 20 sq cm of wound debridement invoving subcutaneous tissue, irrespective of location, we have coded cpt code 11042. For each additional 20 sq cm, or part thereof, an add on code +11045 is used. For 20 sq cm we have code cpt code +11045. Now, we have coded for 40 sq cm.But, still 5 sq cm is left, (45-40=5), so we again use +11045 for the remaining part thereof. Because 11045 is an add-on code, there is no need to append modifier 59.
Dibridement performed on different tissue types should be reported separately. To assign an Excisional debridement CPT codes, the provide must documents the different levels of debridement at different anatomical sites.
For example, in the provider document a wound of left leg 4 cm x 6 cm, and the surgeon irrigates the wound and debrides the subcutaneous tissue and skin. The provider also documents a wound on the right leg 3 cm x 5 cm. But, this wound is deeper than the left leg. The wound of right leg involves the debridement of muscle, subcutaneous tissue and skin. Now how we should report the CPT codes for this scenario. Unlike, above example both wound have different tissue involved and hence should be reported separately. The correct CPT codes for this scenario is CPT code 11042, 11045 and 11043.
Rationale: Because the two wounds were debride to separate depths, the size of the wounds cannot be added together. For left leg we have coded for Debridement of subcutaneous tissue of 24 sq cm (4 x 6 sq cm). Like above example we can code it directly as CPT code 11042 (for first 20 sq. cm) and +11045 (for 4 sq cm for remaining part thereof) . The wound of right leg is 15 sq cm and debrided to muscle. This procedure is reported with 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less.
Wound Debridement Reminders:
1) CPT 11042-11047 carry zero global days.
2) CPT 11045, CPT 11046 and CPT 11047 are all add-on codes; therefore, they are Modifier 51 exempt.
3) When more than one procedure code is performed for a patient on a date of service, be sure to check for NCCI bundling (Encoder) and append a modifier if appropriate.
4) When a CPT code is repeated, consider modifier 59 for commercial carriers and modifier 76 for Medicare
When to code CPT code 97597 and 97598
As I have mention is the begining of this article, there are selective wound debridement procedures as well. CPT codes 97597-97598 is used when a selective debridement is performed. Uninke Excisional Debridement, in selective debridement a non-viable or non-living tissue is removed. They can also be called as Selective wound care management procedure codes.
CPT code 97597 and 97598 should be used only when a nonviable tissue is removed. To report the selective debridement CPT codes like 97597, the document should include the type of tissue removed (nonviable), should describe the method of debridement (scalpel, nippers, scissors, curette) and which deepest layer of tissue was removed or debrided.
Immersion Hydrotherapy (CPT 97022 and 97036) is considered nonselective debridement. For Non-Selective Debridement use CPT code 97022, 97036 and 97602. CPT 97022, 97597 and 97602 are only covered as 1 unit per date of service.
Immersion hydrotherapy for the sole purpose of dressing removal is noncovered.
Limitation with wound debribdement CPT codes
Removal of necrotic tissue by cleansing, scraping (other than by a scalpel or a curette), chemical application, and wet-to-dry dressing.
Washing bacterial or fungal debris from lesions.
Removal of secretions and coagulation serum from normal skin surrounding an ulcer.
Dressing of small or superficial lesions.
Removal of fibrinous material from the margin of an ulcer.
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