Debridements 11000

sknirs@yahoo

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The description for this code is up to 10% body surface. Is there any documentation defining what 10% would be, for example, would a foot be considered 10%. Any direction would be greatly appreciated.
 

becka95

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From my experience the doctor needs to state how much of that body area is debrided. Is it the whole foot or part of the foot? An example of percentages is one leg including the foot is 18% of body surface.
 

sknirs@yahoo

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Thank you for the quick reply. It helps but I have another question, do you know where I can get the documentation, is it based off Medicare guidelines, AMA. I am having some trouble with Medicare denying my claims and in order for me to change our procedures, I need to give my supervisor the supporting documentation. Thanks again.
 

becka95

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Here is a section from the Medicare site. I am not sure what locality you are in so this information may not apply to your situation. There is a website they reference at the bottom.

Procedure codes 11000-11001 and 11040-11044 should be used for debridement of relatively localized areas depending upon the involvement of contiguous underlying structures. These codes are appropriate for treatment of skin ulcers, circumscribed dermal infections, conditions affecting contiguous deeper structures, and debridement of deep-seated debris from any number of injury types.

Recently, the Medical Review department at HGSAdministrators reviewed claims that were suspended for further review for surgical debridement of wounds, procedure codes 11000-11001 and 11040-11044. The majority of issues identified during the reviews related to the lack of an appropriate diagnosis reported to support the medical necessity of the services. However, after reviewing the requested documentation, it was found that the medical record did contain the information to support an ICD-9 code that verified the medical necessity of the services billed, and the claims were allowed. If the appropriate diagnosis had been initially reported on the claim, the claim may not have been suspended for the development of records and may have been paid in a timely manner.

Just as a reminder, please note that surgical debridement codes 11000 11011 and 11040-11044 should not be reported when the service rendered is for removal of benign hyperkeratotic lesions (e.g., corns or callus). The removal of hyperkeratotic tissue (corn or callus) should be reported with procedure codes 11055-11057, as appropriate.

For additional information regarding the ICD-9 codes that support medical necessity, the documentation requirements, and the indications and limitation of coverage and/or medical necessity, please refer to Local Coverage Determination, S-144, “Wound Care”, located on our website at www.hgsa.com.

Here's the site I got it off of:

http://www.cms.hhs.gov/mcd/viewarticle.asp?article_id=37813&article_version=2&show=all

As far as knowing what the percentage of body surface is, there is a picture in the CPT book by the burn care. This would apply to figure out percentage of body area.

Hopefully this helps!:)
 
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Tbsa%

When % of body area is missing, I send the note back to the physician for correction/amendment.

That being said, there are figures in both CPT and ICD9 to help you determine the percent of body area affected.

CPT 2009 professional edition is on page 68 (by CPT code 1600).

2009 ICD-9 for PHysicians, Vol 1 & 2 is on page 315 of vol 1 (just above burn code 948.7)

I like the CPT version better because I'm in pediatrics.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

thorntonc

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What would be the best code to use for a very dry heel and the doctor is doing a "debridement" of the heel. It's best described as very dry skin and the doctor is wanting to remove it.
 

thorntonc

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The codes I have come up with are...11055 paring or cutting of callus/corn.
there is also 11000 which is debridement of eczematous skin....
 
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