Orthopedic Coding Alert

Question: I can't determine whether it's OK to report a debridement code (11010-11012) with an open reduction/internal fixation (ORIF) of a closed fracture. Although the descriptors refer to debridement associated with open fractures, my physician believes he can report the debridement with closed fracture ORIFs. Is he correct?

Pennsylvania Subscriber

Answer: Under some circumstances, it may be appropriate to report the fracture debridement codes (11010-11012) when a wound is associated with a closed fracture.

According to the April 1997 CPT Assistant, -While the debridement codes are intended to be reported in cases of an open fracture, there may be examples when debridement is necessary to treat a fracture site when no open fracture is present.-

For example: A patient has a motorcycle accident and presents with a closed ulnar shaft fracture. He has an open wound that is contaminated with gravel, grass and dirt. The surgeon performs an ORIF of the closed radial fracture and debrides the skin, muscle fascia and muscle to remove the contaminates from the patient's skin.

Solution: You should report the appropriate fracture care code (such as 25545, Open treatment of ulnar shaft fracture, with or without internal or external fixation), along with 11011 (Debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s]; skin, subcutaneous tissue, muscle fascia, and muscle).