Otolaryngology Coding Alert

Question: Our physician wants to code for wound debridement of the hard palate and eye socket, as well as facial and lip wounds, for a patient with a gunshot wound to the face. We are using 40527 for an Abbe-Esterlander lip switch flap. Can we charge separately for the debridements? If so, what codes should we use?

Pennsylvania Subscriber

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Answer: A debridement performed only for preparation of the flap shouldnt be billed, according to CPT guidelines, which indicate that site preparation is incidental to site reconstruction.

In this case, however, the debridements (of the hard palate and eye socket) do not appear to be related to the lip flap, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions in Lakewood, N.J.

Because the injuries probably involve fractured bones, 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) or 11012 (... skin, subcutaneous tissue, muscle fascia, muscle, and bone) may be separately billed, depending on the depth of the debridement.

If a debridement is performed on a different part of the lip that is unrelated to the flap, modifier -59 (distinct procedural service) should be appended to the appropriate debridement code to let the carrier know the debridement was performed at a separate site and should not be bundled with the repair.

Because the hard palate and eye socket are unrelated to the lip repair, modifier -59 should not be necessary, although you may wish to append the modifier in case the carriers software inadvertently bundles all debridements to the repair.