Editor’s Note: Updated May 2022, to see the old article, please click here.
There are lessons to be learned to avoid damaging coding habits.
Wound debridement is a medical procedure that removes infected, damaged, or dead tissue to promote healing. Debridement is generally associated with injuries, infections, wounds, and/or ulcers. It is also a procedure that may be part of fracture care as well, and it is separately payable. To better understand how to code for wound debridement properly, let’s first look at why debridement is performed, and how it’s accomplished.
CPT® codes 11042-11047 describe the work performed during wound excisional debridement. An excisional debridement can be performed at a patient’s bedside or in the emergency room, operating room (OR), or physician’s office. Some key elements to look for in the documentation are:
- The technique used (e.g., scrubbing, brushing, washing, trimming, or excisional)
- The instruments used (e.g., scissors, scalpel, curette, brushes, pulse lavage, etc.)
- The nature of the tissue removed (slough, necrosis, devitalized tissue, non-viable tissue, etc.)
- The appearance and size of the wound (e.g., fresh bleeding tissue, viable tissue, etc.)
- The depth of the debridement (e.g., skin, fascia, subcutaneous tissue, soft tissue, muscle, bone)
To determine the proper code choice, first, consider the depth of the debridement. This is determined by the deepest depth of removed tissue. Keep in mind that the wound may extend to the bone, but if only subcutaneous tissue is removed, the depth of debridement is only to the subcutaneous tissue.
The second aspect of picking the proper wound debridement code is determining the surface area of the wound. If the entire wound surface has been debrided, the surface area is determined by the square centimeters (sq cm) of the wound after the debridement has been completed. If only a portion of the wound is debrided, report only the measurement of the area debrided.
Also, know that there are what Medicare calls “MUEs”, which are medically unlikely edits. This means how many times you can report the same code on the same date.
The add-on code, 11045, “…each additional 20 sq. cm, or part thereof (list separately in addition to code for primary procedure), has an MUE of 12.
Example 1: A patient with a 4 cm x 4 cm ulcer on his calf requires debridement of necrotic subcutaneous tissue. After the debridement is complete, the area measured 5 cm x 5 cm. Because the whole area was debrided, we code based on the final measurement of 5 cm x 5 cm (25 sq cm).
The codes for this case are 11042 and 11045.
Example 2: The same patient has a 4 cm x 4 cm ulcer on his calf, but over half of the ulcer was healing. The surgeon states that she debrided necrotic tissue on a 1 cm x 1 cm section. Code selection is based on the 1 cm x 1 cm section (1 sq cm).
The code for this case is 11042.
Wound Care Management
The CPT® codebook directs us to use the Active Wound Care Management codes 97597-97598 for debridement of the skin (i.e., epidermis and dermis only):
Selective debridement is the removal of non-viable tissue, with no increase to wound size and typically no bleeding because the tissue removed is non-viable. Non-selective wound debridement is usually done by brushing, irrigation, scrubbing, or washing of devitalized tissue, necrosis, or slough. In non-selective wound debridement, the focus goes beyond the non-viable tissue.
Example 1: The patient has a pressure ulcer. The physician examines the ulcer and uses a pressure waterjet to debride the skin and eschar from the wound. The wound is left open to continue healing. This is an example of selective or active wound care management, CPT® codes, 97597-97598.
Fracture and Dislocation Debridement codes 11010-11012 are based on the depth of the tissue removed, and whether any foreign material was removed at the same time.
Repeat debridement may be necessary for certain circumstances. When coding for a “staged” or “planned” debridement during the usual postoperative follow-up period of the original procedure/fracture and it’s important to use the appropriate modifiers.
Example: The patient was in an automobile accident and sustained an open fracture of the left femur. On the day of the accident, the patient was brought to the OR and the open fracture was debrided of all necrotic tissue and debris. Under fluoroscopic guidance, the surgeon was able to manipulate the bone to create an ample reduction. The debridement would be 11010 along with the open fracture code 27269
Two days later, the patient was returned to OR and the dressing is removed. The surgeon examined the open fracture and irrigated the wound with saline. An area of 3 cm x 4 cm was dark and dusky looking. The subcutaneous tissue and skin were excised with a #15 blade to bleeding tissue. Some nonviable muscle tissue was also debrided. The area was then copiously irrigated and a dressing was placed.
Coding for the second debridement is 11011-58.