Dig Deep into Debridement

Dig Deep into Debridement

Shed damaging coding habits and promote healthy reporting of wound debridement procedures.

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 ulcers. To better understand how to code properly for wound debridement, let’s first look at why debridement is performed, and how it’s accomplished.

Wound Debridement

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 the wound may extend to the bone, but if only subcutaneous tissue is removed, the depth of debridement is to the subcutaneous tissue only.

Wound Surface Biofilm, Epidermis, Dermis 

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
each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

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)

Muscle or Fascia 

11043 Debridement, muscle and/or fascia (includes epidermis, 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)

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 (List separately in addition to code for primary procedure)

When debridement is performed to the same depth on more than one wound, the surface area of the wounds is combined. When the depth is different for two or more wounds, each wound is coded separately.

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 actually debrided.

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.

Example 3: The patient was in a motorcycle accident and has several abrasions on both arms, but no broken bones. The wounds are: left forearm 3 cm x 3 cm (9 sq cm); right shoulder 2 cm x 2 cm (4 sq cm); and right forearm 6 cm x 5 cm (30 sq cm). The patient is taken to the operating room and the surgeon performs a debridement of skin, subcutaneous tissue, and muscle in all three wounds. Because all three wounds are debrided to the same depth, we add the size together to determine the correct CPT® code(s).

The codes for this case are 11043 and 11046 x 2.

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):

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
each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Notice the description states “selective debridement,” verses “non-selective,” as captured by 97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.

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 wound care, 97597-97598.

Example 2: The patient comes into the wound clinic for treatment of an open wound on the left thigh. It’s noted the deeper layers of the wound are healing very well. The provider uses a brush to scrub and wash the wound, removing all nonviable skin. The provider then dresses the wound with non-adherent gauze. This is an example of non-selective wound care, 97602.

Fracture Debridement

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.

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

11011 skin, subcutaneous tissue, muscle fascia, and muscle

11012 skin, subcutaneous tissue, muscle fascia, muscle, and bone

Repeat debridement may be necessary in certain circumstances. When coding for a “staged” or “planned” debridement during the usual postoperative follow-up period of the original procedure, it’s important to use the appropriate modifiers.

  • Use modifier 58 Staged or related procedure or service by the same physician or qualified health care professional during the postoperative period in the following instances:
  • When the debridement procedure(s) are staged prospectively at the time of the original procedure, or during the usual postoperative follow-up period of the fracture treatment.
  • When the staged procedure is more extensive than the original procedure. For example, when an initial debridement procedure(s) is performed and a larger procedure (e.g., definitive open fracture treatment) is a staged surgical intervention.
  • When other reconstructive procedure(s) (e.g., skin graft, myocutaneous flap, vessel graft) are planned or staged prospectively at the time of either the original procedure or during the usual postoperative follow-up period of other reparative procedure(s) and/or fracture treatment.

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. An external fixator device was used and a dressing was applied to the open area.

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 was 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.

Resources:

CPT® Assistant, October 2012; volume 22, issue 10, “Debridement of Open Fracture/Dislocations”

CPT® Assistant, May 2011; volume 21, issue 5


 

Michelle Hafford, CPC, is a manager, professional coding services, for Reimbursement & Advisory Services at Altegra Health, Inc. She has more than 10 cumulative years in the medical coding and billing field. Hafford has extensive experience in multi-specialty surgical and evaluation and management services. She specializes in coding and compliance with responsibility for large-scale clients including academic centers. Hafford is a member of the Bangor, Maine, local chapter.

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3 Responses to “Dig Deep into Debridement”

  1. Natalie says:

    Hi, can someone shed light on the max units that can be billed for the add-on cpt 97598? Through research, I’ve seen two different answers.
    1. a max of 4 units per line for 97598, the 2nd entry of 97598 (with additional units) must have a 59 modifier. My additional line with the 59 Mod was denied.

    2. I read somewhere that Medicare only allows a max of 4 units per day.

  2. ASaiz says:

    Thank you for your comment. You’ll find a lot of suggestions and better answers to your question in the Member Forums.

  3. Frankie Whitlatch says:

    Can you bill for supplies such as Silver Alginate, Medihoney Gel, Foam Dressings? If you’re a clinic?

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