Both Depth and Area Matter when Reporting Debridement

Correct coding of surgical debridement (11042-11047) requires documentation of both the measurement of the wound surface area after debridement and the depth of tissue that is removed. The Centers for Medicare & Medicaid Services (CMS) contractor Palmetto GBA has issued a primer on proper coding for 11042-11047, and wants you to know, “The measurement and documentation should be part of your standard operating procedures for surgical debridement. Establishing such a process will help you avoid claims submission errors, denials for insufficient documentation, and potential overpayments.”

Codes describing excision debridements deeper than skin only are organized by depth:

  • Subcutaneous tissue (includes epidermis and dermis, if performed) – 11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less and +11045 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
  • Muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed) – 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less and +11046 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
  • Bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed) – 11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less and +11047 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

The deepest level of tissue removed from a uniquely identifiable wound determines the correct code. Do not report 11043 when muscle and tendon are visible, but were not actually surgically debrided. Nor should you report 11044 when bone is visible, but not documented as being part of the surgical debridement procedure.

For example, a 65-year-old patient with diabetes presents with a 5 cm x 4 cm ulceration (20 sq cm) involving the skin and subcutaneous tissue of the left heel. The physician examines the ulcerated area for size, depth, location, and staging. Using a scalpel, he excises (removes) the necrotic skin and subcutaneous tissues to the level of viable tissue, and then irrigates the wound.

Proper coding in this case would be 11042. Had the area of the wound been 30 sq cm (e.g., 5 cm x 6 cm), proper coding would be 11042, 11045.

When reporting add-on codes for additional area (e.g., 11045-11047, as in our example above), documentation should specify the area of the tissue removed, “and not routinely set as being equal to the total area of the wounds in question. This latter point is particularly important in Electronic Health Records (EHRs) that are capable of automating the completion of key data elements based on certain pre-populated fields,” Palmetto GBA advises.

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