ED Coding and Reimbursement Alert

Coders should be ready for higher-level services just in case.

ED physicians' debridement services are typically skin deep.There is always a chance, however, that they'll have to perform a more involved debridement. "Deeper debridements are often performed in the OR but might be performed in the ED, especially if the patient has wounds in locations where there is not much tissue overlying the muscle or bone," relays Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians and Children's University Medical Group Compliance Program.

When deeper debridements occur, proper coding could net your ED several hundred dollars per encounter.

The three highest-level debridement codes in CPT are:

• 11042 (Debridement; skin and subcutaneous tissue)
• 11043 (... skin, subcutaneous tissue, and muscle)
• 11044 (... skin, subcutaneous tissue, muscle and bone).

ED physicians might be more likely to perform these procedures if they are working in an understaffed hospital. They'd also provide these services "more frequently in smaller underserved areas," explains Bucknam.

Example: A patient presents to a small rural hospital after suffering a chainsaw accident that penetrated his forearm and caused extensive damage. The ED physician controls the bleeding and cleans the wound, performing debridement of heavily contaminated tissue. including the skin, subcutaneous tissue, and muscle. The physician then transfers the patient to a larger facility in the next county.

In this scenario, you'd report 11043 for the service. Bug Physicians If They're Not Noting Depth of Service In the above example, choosing 11042 instead of 11043 is a costly mistake. The average payout for 11042 is $43 (1.17 transitioned facility relative value units [RVUs] multiplied by the current Medicare conversion factor of $36.8729). The 11043 code pays about $230 (6.26 RVUs multiplied by $36.8729).

Caveat: Most EDs will rarely have the opportunity to code these debridements. You must be sure that the documentation reflects debridement to the level you are coding -- so if the notes indicate that the physician performed "Skin/subQ debride," 11042 is the highest-level code you should consider.