Podiatry Coding & Billing Alert

Hint: Distinguish wound debridement codes from active wound care management.

When your podiatrist needs to perform a debridement service, you want to make sure you follow all of CPT^®’s reporting rules so you can submit a clean claim. For example, you need to know when to report a wound debridement code from an active wound care management code. You must also know the surface area of the wound.

Read on to learn more.

Discover Codes in Integumentary Debridement Section

When you look in the debridement section of the CPT^® manual, you will find numerous code options to choose from. Some of the codes you may see in your podiatrist’s medical documentation include the following:

• For debridement of extensive infected or eczematic skin, use 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface) and possibly +11001 (… each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure)), depending on the surface area.
• For debridement that includes removing foreign material at an open fracture/ dislocation site, turn to 11010 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissues)-11012 (… skin, subcutaneous tissue, muscle fascia, muscle, and bone) depending on the depth of the work.

Codes 11042-+11047: The main codes you may encounter in this section include 11042-+11047, which describe debridement for injuries, infections, wounds, and chronic ulcers, according to CPT^®. These are all excisional procedures, involving the removal of abnormal tissue such as eschar, slough, granulation, or necrosis to reach viable tissue. You’ll find the following three code families here, distinguished by the debridement depth:

• 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))
• 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))
• 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))

Coding example: The podiatrist performed debridement of a stage 1 pressure ulcer in the patient’s right ankle to allow the wound to stay open and heal. The podiatrist debrided the subcutaneous tissue, including the epidermis and dermis, of 15sq cm of the ulcer.

Coding solution: You should report 11042 for the debridement service. You should also report L89.511 (Pressure ulcer of right ankle, stage 1) as the ICD-10-CM code on your claim.

Mind These Surface Area Rules

You should report codes 11042-+11047 “by depth of tissue that is removed and by surface area of the wound,” according to CPT^®. You can report codes 11042-+11047 for injuries, infections, wounds, and chronic ulcers.

If your podiatrist performs debridement of a single wound, you should report the depth of the deepest level of tissue removed, per CPT^®.

On the other hand, if your podiatrist performs debridement of multiple wounds, you should sum the surface area of the wounds that are at the same depth. Do not combine sums from different depths.

Distinguish Active Wound Care Management

Active wound care management involves procedures such as debriding areas of devitalized tissue using a process such as sharp excision, high-pressure waterjet, or non-selective processes such as abrasion or enzyme treatments. According to CPT^® guidelines, the intent of these procedures is “to remove devitalized and/or necrotic tissue and promote healing.”

You’ll report these procedures using codes such as the following:

• 97597 and +97598 (Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, 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…)

• 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session)

Although the surgeon’s work may be similar for some wound debridement codes as active wound care management, don’t confuse the two groups of codes.

Key: Active wound care management involves epidermis and dermis only. On the other hand, “the wound-debridement codes 11042-+11047 all involve deeper layers,” says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. That’s why CPT^® text notes in the Debridement section direct you, “For debridement of skin [ie, epidermis and/or dermis only], see 97597, +97598.”

Recognize Specific Type of Debridement Codes

If your surgeon performs certain specific types of debridement procedures, you’ll need to turn to other code families. CPT^® provides specific codes in conditions such as burns or pressure ulcers. Text notes in the Debridement and Active Wound Care Management sections point you to some of these codes.

You should be aware of the following code families:

• For dermabrasions, turn to 15780-15783.
• For nail debridement, use 11720 and 11721.
• For debriding burns, look to 16020-16035.

Coding example: Your podiatrist removes and excessive nail structure to correct excessive curvature of a diseased or dystrophic nail. Your podiatrist debrides two nails. You should report 11720 (Debridement of nail(s) by any method(s); 1 to 5) for this service.