Wiki Debridement 11042

[mistypace]

I am looking for some clarification on debridement code 11042. The description in CPT reads "Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less"
Myself and a couple other coders interpreted this as debridement of dermis/epidermis but not going all the way past dermis could be billed. Medicare had a webinar on debridement and stated debridement must go below the dermis in order to charge code 11042.

I am able to admit when I am wrong so I am just looking for clarification to make sure I am not misunderstanding. Thank you.

 

[thomas7331]

Medicare is correct. There's an instructional note in CPT that explains the use of the debridement codes, where it states to "report depth using the deepest level of tissue removed." So in order to use the debridement code 11042, there has to be documentation that subcutaneous tissue was removed. If the record only indicates that skin was removed (i.e. dermis/epidermis only), this does not satisfy the coding requirement for 11042 since you would be coding a depth that was more than what was documented. (The part of the code description stating 'includes epidermis and dermis, if performed', means that any skin tissue removal done in addition to the subcutaneous debridement would be included in code 11042, but by itself is not sufficient.)

97597 would be the correct code for excisional debridement if only skin tissue is removed.

 

[mistypace]

Thank you very much for the explanation! I thought I was misunderstanding but needed to confirm. Thanks!