Podiatry Coding & Billing Alert

Question: A patient presented to the podiatrist with a venous-related ulcer on the left dorsal foot measuring 3 x 2 cm. The ulcer had a fibrinous slough base, which the podiatrist removed along with nonviable dermis with a curette down to bleeding granulation tissue. The documentation also notes that no subcutaneous tissue was removed. Our code system defaulted to 11042, but I think the procedure code should be 97597. Which code is correct?

Missouri Subscriber

Answer: You are correct! Assign 97597 (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; first 20 sq cm or less) to report the debridement of the venous-related ulcer on the top of the left foot. According to the Centers for Medicare & Medicaid Services (CMS) billing and coding article A58565, “The wound depth debrided determines the appropriate code.”

Code 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less) involves treatment down to the subcutaneous tissue, which makes this code incorrect for the procedure performed. You noted in your question that the podiatrist only treated the dermis and down to the granulation tissue.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC