Orthopedic Coding Alert

Question: Can I bill for debridement (11010) when billing for 25575? Insurance companies keep denying this claim.

Texas Subscriber
 
Answer: Codes 11010 (debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s]; skin and subcutaneous tissues), 11011 (... skin, subcutaneous tissue, muscle fascia, and muscle) and 11012 (... skin, subcutaneous tissue, muscle fascia, muscle, and bone) were specifically written to document the additional intraoperative work sometimes associated with the treatment of open fractures, and, per the American Academy of Orthopedic Surgeons (AAOS) Complete Global Service Data Guide, these services are not bundled with 25575 (open treatment of radial AND ulnar shaft fractures, with internal or external fixation; of radius AND ulna). Carriers have no obligation to adhere to the AAOS, but if these claims are consistently denied, copy the page of the AAOS guide and prepare a brief letter for your claims.
 
If your practice has a contract with a carrier that habitually denies these services, your surgeon should write a letter of appeal to the medical director to try to settle the issue across the board rather than writing individual appeals on a per-case basis. A word of caution though: It is appropriate to report 11010-11012 only when a formal debridement with removal of particulate matter or devitalized tissue is performed. These codes should not be reported when only pulsatile lavage is used.