Orthopedic Coding Alert

Multiple debridements can mean multiple codes … sometimes.

When your orthopedic surgeon needs to perform debridement on a patient, things can get confusing fast when there are multiple injury sites, or multiple levels of complexity.

For example, what should you do when the provider performs more than one debridement in separate anatomical areas? How about debridements of different depths during the same encounter?

Help’s here: We’ve got the straight dope from the experts on how to code each of these multi-debridement scenarios.

Check Depth of Each Debridement

Your first step toward ensuring a valid debridement claim should always be determining the depth of each debridement. You’ll choose from the following codes for these services, confirms Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AAPC Fellow, AHIMA-approved ICD-10 CM/PCS trainer, and president of Maggie Mac-Medical Practice Consulting in Clearwater, Florida:

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

So, if the operative notes indicate that the provider performed 32 sq cm of fascia debridement, you’d report 11043 and +11046 for the service.

Add Areas of Same Depth

When the orthopedic surgeon performs the same-level skin debridement on a patient in two separate anatomical areas, “you would add the surface area together and code based on the total surface area,” confirms Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, New Jersey.

Example: An established patient reports to the orthopedist with wounds to his right and left legs. After a level-three evaluation and management (E/M) service, the orthopedist debrides a 15 sq cm subcutaneous wound of the patient’s right leg and a 20 sq cm subcutaneous wound of the patient’s left leg. For this encounter, you’d report:

• 11042 for the first 20 sq cm of debridement
• +11045 for the remaining 15 sq cm of debridement
• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. …) for the pre-debridement E/M service
• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99213 to show that the E/M service was separate and distinct from the debridements.

Important: If the provider debrides the entire wound surface, then you’d take the measurement of the wound after the procedure, explains Brink. If the provider debrides a portion of the wound, report only the area of the wound that was debrided, she says.

Different Depths = Different Codes

When your orthopedic provider performs debridements of different depth on the same patient during the same encounter, you’ll likely need help from modifier 59 (Distinct procedural service), Brink explains. This is due to Correct Coding Initiative (CCI) edits, which forbid you from reporting multiple debridement depth codes unless you can prove that there were debridements of separate depths (in other words, distinct procedural services).

Example: Operative notes indicate that the surgeon performed a 15 sq cm subcutaneous debridement on a patient’s left shin, and an 18 sq cm debridement to the muscle on a patient’s left thigh. In this scenario, you should report 11043 for the thigh debridement, along with 11042 for the shin debridement. Don’t forget to append modifier 59 to 11042 to show that the shin debridement is a separate service from the thigh debridement.

“If the medical record documentation indicates the wounds are in different anatomical sites, and both 11042 and 11043 are properly documented, then 59 is appropriate and should always be appended to the secondary or component code in CCI combination,” explains Brink.

Remember Dx Codes, Modifier Placement

When you are reporting debridements — especially debridements of multiple depths — you need to make sure your diagnosis coding is on point, Mac advises. On multi-depth debridements, “diagnoses should be very specific to each part of the body in order to prove that you have two separate places, areas or depths,” she explains.

You also need to remember to append modifier 59 to the lower-paying code, Mac says, as the code with modifier 59 appended will be paid at 50 percent of the standard rate.

“If you put the modifier on the higher-paying code, you’re going to lose money. Always report the deepest level of the tissue [debridement] first,” explains Mac.

Seal the Deal With Documentation

Once you’ve got the CPT^® and ICD-10 coding, and modifiers, down on your multiple-depth debridement encounter, you’ve got to ensure that the documentation is solid to make your claim as stout as possible, Brink says.

It is important to document the different levels of debridement the physician performed in order to be paid for multiple-depth debridement encounters, Brink explains. “The medical record documentation must state the level of debridement performed. Remember, if it is not documented, it was not performed.”