could someone explain to me the difference between code 11005 and 11042and 11045 add-on. i have a necrotic abdominal wound measuring 27 x14 x4, skin and subq tissue, insurance seems to deny any add-on after the first one............
According to EncoderPro's Coding Tips, here's the additional descriptions for your mentioned codes:
- Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure
- This type of debridement is done on high-risk patients who have life-threatening infection such as Fournier's gangrene. Necrosis is often caused by infection from a combination of dangerously virulent micro-organisms. Fistulas, herniations, and organ destruction may occur, requiring an extensive level of repair involved with the debridement. Tissue flaps or skin grafting are reported separately when used for repair or closure. For removal of prosthetic material or mesh from the abdominal wall, see 11008. Report skin grafts or flaps separately when performed for closure at the same session as 11004-11006.
11042 - Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less 11045 - Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
- Code 11045 is a resequenced code and will not display in numeric order.When reporting debridement of a single wound, the deepest level of tissue removed determines the correct code. The debridement of multiple wounds at the same tissue level may be added together to determine the appropriate code. Different tissue depths should not be added together for code selection. According to the AMA, the debridement of skin (epidermis/dermis) is reported with the codes describing active wound care management (97597 or 97598). Surgical trays, A4550, may be separately reimbursed by third-party payers. Check with the specific payer to determine coverage.
Based on your comments, I would expect 11005 to be the more appropriate code to report, though I have asked TRG's medical advisor and the American College of Surgeons representative to the AMA CPT, Dr. Christopher Senkowski, for additional comment.
I can tell you that Dr. Senkowski always advises measuring the wound POST debridement, and to take a picture of the POST-debrided wound and retain it in the patient's record to support your coding decisions.