Revitalize Integumentary Coding in 2011

New debridement codes and revised descriptors will help to capture services accurately

By G.J. Verhovshek, MA, CPC, and Terri Brame, MBA, CHC, CPC, CGSC, CPC-H, CPC-I

Revisions to CPT® 2011 for integumentary-related services involve three families of debridement codes. Debridement is the removal of dead or infected tissue to improve healing of remaining, healthy tissue. Various methods—including surgical (sharp debridement), mechanical (e.g., hydrotherapy), and chemical—may be used.

Codes 11010-11012 Are Refined, Not Redefined

The first family of debridement codes to undergo revision is 11010-11012. New, standardized descriptor language clarifies the intent of these codes, but does not alter their use from previous years (new text for 2011 is underlined, deleted text is struck-through).

11010  Debridement including removal of foreign material associated with at the site of an open fracture(s) and/or an open dislocation(s) (eg, excisional debridement); skin and subcutaneous tissues

11011  Debridement including removal of foreign material associated with at the site of an open fracture(s) and/or an open dislocation(s) (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle

11012  Debridement including removal of foreign material associated with at the site of an open fracture(s) and/or an open dislocation(s) (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone

Note the specific circumstances under which you may report these codes:

  • The debridement must occur at the sight of an open fracture or dislocation. An open fracture occurs when bone pierces the skin; an open dislocation (compound dislocation) is dislocation complicated by a wound opening from the surface to the affected joint. Code debridement for other reasons/sites differently (e.g., 16020-16030 for debridement of burn wounds).
  • Debridement must reach to at least the level of skin and subcutaneous tissue (11010), but may reach as deep as muscle (11011) or bone (11012). Documentation must specify precisely the depth of debridement. Report debridement of skin only (as well as active wound care management) with 97597 or 97598.

For example, a motorcyclist loses control on a wet road and suffers a compound fracture of the ulna, with extensive “road rash” directly over the fracture that requires debridement down to muscle. The debridement portion of this procedure is reported with 11011 (open fracture repair is reported separately, per the documentation).

Report 11042-11047 by Square Centimeters

Codes 11042-11044 have been revised and their family has grown with the addition of 11045-11047. These codes describe debridement at various depths, and now are reported by the total square area treated.

To the depth of subcutaneous tissue:

11042      Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less

+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)

To the depth of muscle and/or fascia:

11043      Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less

+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)

To the depth of bone:

11044      Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less

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)

Once again, debridement of skin (epidermis and/or dermis) only should be reported using wound care codes 97597-97598. These codes previously were reported only by nonphysician providers, but may now be reported by any billing provider. In addition to depth, the total area treated must be documented. The standard unit of measurement for these codes is 20 sq cm.

The AMA’s CPT® Changes 2011: An Insider’s View offers the following example:

A 74-yr-old diabetic female with limited mobility presents with a 4.0 cm x 3.5 cm posterior heel ulceration involving the skin and subcutaneous tissues and Achilles tendon/muscle. She requires debridement of the wound, including debridement of the tendon/muscle.

Because debridement occurs to the level of muscle, our code choices are 11043-+11046. The total area treated is 4.0 cm x 3.5 cm, or 14 sq cm. This is reported using a single unit of 11043.

In a second example, the surgeon performs debridement to the depth of bone. The total area is 48 sq cm. This is reported with 11044, 11047 x 2.

11044   first           20 sq cm

11047   additional  20 sq cm

11047   additional  08 sq cm

Total 48 sq cm

You may report the add-on codes if even 1 sq cm beyond the first 20 sq cm is debrided. For instance, if the area in the above example had been 7 cm x 3 cm (21 sq cm), you would then report 11044 for the first 20 sq cm and 11047 for the remaining 1 sq cm.

Skin Only Debridement Now Coded 97597-97598

Deleted are codes 11040 and 11041, which in previous editions of CPT® described debridement of skin, partial or full thickness. As a result, active wound care codes 97597 and 97598 are revised to include these procedures:

97597     Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less

+97598   Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

These codes describe active wound care of the skin, dermis, or epidermis. For debridement below the level of skin, refer to integumentary codes (e.g., 11042-11047). Consider also 16020-16030 for certain (but not all) burn debridements, and pressure ulcer excision codes when a pressure ulcer is debrided and closed (if the ulcer is not closed, 1104x codes apply).

Codes 97597-97598 also are revised to include sharp, selective debridement. Previously, the codes only included nonselective debridement. Because any type of debridement now applies, the level of debridement (skin) determines when 97597-95978 are appropriate.

When reporting 97597 or 97598, consider several points:

  • Per CPT®, “Provider is required to have direct (one-on-one) patient contact.” This hands-on contact should be documented.
  • Total area treated must be documented to code appropriately.
  • Codes 97597-97598 should not be reported with 11042-11047 for the same wound.
  • Add-on codes apply if even 1 sq cm beyond the first 20 sq cm is treated.

For example, a diabetic patient has a chronic open wound on the lower right leg, measuring 6 cm x 5 cm (30 sq cm). The physician determines that selective active wound care management is appropriate to threat the wound. The treatment is reported 97597, 97598.

 

G. John Verhovshek, MA, CPC, is director of editorial development/managing editor at AAPC.

 

Terri Brame, MBA, CHC, CPC, CGSC, CPC-H, CPC-I, is the director of coding and charge capture for University of Washington Physicians, a practice group of over 1,500 physicians and health care providers associated with UW Medicine. She is a past AAPC local chapter president, and has had the opportunity to speak at two AAPC national conferences.

2017-code-book-bundles-728x90-01

 

Latest posts by admin aapc (see all)

Leave a Reply

Your email address will not be published. Required fields are marked *