General Surgery Coding Alert

Question: Our surgeon treated a patient with severe diabetic ulcer on his lower leg. He debrided the 16 sq. cm. wound down through subcutaneous tissue and applied sterile dressing. I was going to report 11042, but another coder in the office suggests 97597. Which code is correct?

Virginia Subscriber

Answer: You should report 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq. cm or less) or similar code, depending on the wound size. Debridement codes are based on the depth, which in the scenario you describe, involves subcutaneous tissue.

You shouldn't confuse the depth of debridement with the depth of the wound. Code 11042's definition includes "skin and subcutaneous tissue" but does not include the muscle and bone.

Heads up: The debridement code includes reimbursement for the dressing application, so you may not code separately for that service or supplies.

You shouldn't report 97597 (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]) because this code indicates that the surgeon used a waterjet and that the patient was not under any kind of anesthesia, either local or general. The code does not describe the scenario you mentioned.