Wiki Cpt 11000

[sorcha48]

I have a provider that wants to be this CPT for debriding fissured skin on the heel.
He has stated that this he had this billed at another practice with no problems.
I have tried explaining 11000 is for "extensive".

Can anyone help me? Is he right and why? Or am I right and where other than the CPT book can I show him?

 

[OCD_coder]

When in these challenging situations I try to find an LCD (Local Coverage Determination) to explain the medical necessity requirements to support billing a CPT code.

A fissure doesn't seem to meet the CPT description of "eczematous or infected", but not seeing the procedure note I'd hate to say it isn't codable. Check out the attached LCD to guide your education of the provider.

LCD for Debridement Services (L27373)

Indications:
Debridement is indicated for any wound requiring removal of deep seated foreign material, devitalized or nonviable tissue at the level of skin, subcutaneous tissue, fascia, muscle or bone, to promote optimal wound healing or to prepare the site of appropriate surgical intervention.

CPT codes 11000 and 11001 describe removal of extensive eczematous or infected skin. A key word is extensive. Conditions that may require debridement of large amounts of skin include: rapidly spreading necrotizing process (sometimes seen with aggressive streptococcal infections), severe eczema, bullous skin diseases, extensive skin trauma (including large abraded areas with ground-in dirt), or autoimmune skin diseases (such as pemphigus).