General Surgery Coding Alert

Resolve wound care questions with this advice.

Confused about when to choose a debridement code or an active wound care code? CPT 2011 comes to your rescue with revised codes and guidelines that clarify how to choose between the two code groups.

Past uncertainty about choosing between debridement and wound care code families has led to Office of Inspector General (OIG) scrutiny of these claims. Accordingly, the CPT 2011 revised coding for debridement and wound care "reflect CMS's continued concern with perceived billing abuses," explains M. Trayser Dunaway, MD, a surgeon, speaker, coding educator and healthcare consultant in Camden, S.C.

Depth is the Bottom Line

Based on 2010 and older CPT codes, you had to consider lots of factors when choosing between debridement and active wound care codes. Not anymore.

"Depth is the only documentation item you need to determine the correct code," explained Chad Rubin, MD, FACS, American College of Surgeons AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member at the "General Surgery" presentation of the CPT and RBRVS 2011 Annual Symposium in Chicago.

Distinguish codes this way: Active wound care, which has a 0-day global period, is for treating wounds of the skin, dermis, or epidermis. For deeper wound care, use the appropriate debridement codes from CPT's integumentary surgery section as discussed below.

To further enforce the depth distinction, CPT 2011 deletes the following two debridement codes that refer only to dermis or epidermis:

• 11040 -- Debridement; skin, partial thickness
• 11041 -- ... skin, full thickness.

You'll also see a new parenthetical note under the deleted codes that reads "For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598."

Size Matters for New and Revised Debridement Codes

Continuing the focus on depth, CPT 2011 revises the debridement code definitions to list first the deepest level involved in the debridement procedure, and add a statement that the procedure also includes all layers that are more superficial. For instance, CPT 11042 used to read "skin and subcutaneous tissue," but in 2011 it reads, "subcutaneous tissue (includes epidermis and dermis, if performed)."

Code for area, too: The new and revised codes now make it possible for you to capture work for debridement services on areas greater than 20 sq. cm. Look at the following CPT 2011 codes to understand how you'll use depth and area to choose appropriate coding:

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

Note that the new codes are out of numerical sequence (#) and are add-on codes (+) to capture each additional 20 sq. cm beyond the first 20 sq. cm for each debridement depth.

Watch global days: Codes 11043 and 11044 change from 10 global days to 0 global days in 2011. "This is a critical change, especially for patients who require serial debridements or who have debridements due to postop infections, where you would not bill Medicare for follow up visits, but you can starting Jan. 1 because there is no global period," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program.

Turn to Revised Medicine Codes for Wound Care

CPT 2011 wound care code revision involves "mainly rewording to make clear how active wound care is separate from integumentary wound care," explained Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member at the "General Surgery" presentation of the CPT and RBRVS 2011 Annual Symposium in Chicago.

The code changes also allow you to capture larger areas, as follows:

• 97597 (Revised) -- Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (e.g., 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
•  + 97958 (Revised) -- ... each additional 20 sq. cm, or part thereof (List separately in addition to code for primary procedure).

Watch guidelines: CPT 2011 includes guidelines that indicate two requirements for active wound care management. These guidelines stress:

• Intent: "Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing."
• Contact: Direct patient contact is required.

Non-physicians may perform wound care: The June 2005 CPT Assistant states, "Codes in the active wound care management series provide a mechanism for reporting interventions associated with active wound care as performed by licensed nonphysician professionals."