Debridement of necrotic tissue


Wasilla, AK
Best answers
Patient is seen in the urgent care for a laceration (cut tip of pinky finger). Returns for a 2nd follow-up appointment and physician documents on exam "open wound of 4th finger... wound of left 5th finger, eschar debrided off of finger tip 1x1 cm area." For the Procedure: Debridement of necrotic tissue left finger tip 1x1 x.5 cm sharp dissection of necrotic tissue.
CPT 11043 for debridement first 20 sq cm or less.
Is this enough documentation to support the charge? Would you bundle this into the E/M?


Best answers
Necrotic tissue just means dead or devitalized tissue and could be very superficial (skin level) or in the deeper tissues such as the muscle/fascia. The documentation does not specify the depth of tissue debrided in terms of skin, subcutaneous, fascia, muscle, or bone. That detail is needed to accurately code the debridement procedure. I would ask the physician for more information to confirm in this case.

In terms of the E/M and whether the debridement would bundle into it, if the patient was seen initially and then brought back for follow up to treat the wound, the E/M would bundle to the debridement rather than the other way around. I would not report an E/M in addition to the debridement unless the E/M was significant, separately identifiable (performed for a reason unrelated to this wound and the planned treatment or a patient requiring additional workup). Here is a guideline from the NCCI Policy Manual that may help (the debridement codes have a global period of 000 and would be subject to this guideline):

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure, and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.
Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.

I hope that helps :)