Surgical and selective debridement documentation requirements

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I'm auditing both surgical and selective debridement procedures (CPT11042-11047, 97597, 97598) and am finding the wound size is always documented, however it varies or is unclear if this measurement occurs before beginning the procedure or after the completion of the debridement. Is there a standard of whether this should always be a post-debridement measurement?

Furthermore, in my LCD (Novitas L35125), it seems to state the dimensions of the wound both before and after the procedure are required. Is this a correct interpretation of documentation requirements (below)?

Novitas LCD35125, General information, Documentation Requirements:

"[...]
7. When debridements are reported, the debridement procedure notes must demonstrate tissue removal
(i.e., skin, full or partial thickness; subcutaneous tissue; muscle and/or bone), the method used to debride
(i.e., hydrostatic, sharp, abrasion, etc.) and the character of the wound (including dimensions, description
of necrotic material present, description of tissue removed, degree of epithelialization, etc.) before and
after debridement
.
[...]"
 

ellzeycoding

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Coding is based on the final size of the debrided area in sq cm for the 11042-11047 codes.

The final debrided "area" may extend slightly beyond the actual wound itself.. (think overlap).

Since you are essentially "removing" the initial wound, you document both the initial wound size and the final debrided area that results after treatment.

An analog to this would be a lesion that is excised... you have the size of the initial lesion before excision, and the final size including margins that is used for code selection.

Does that make sense?
 
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Thank you! It does make sense.

Are the selective debridement codes (97597) not held to these same documentation requirements as the surgical debridement codes (11042-11047)?

If the pre and post debridement measurements are not documented is it ok to code it as a selective debridement (97597)? Or must you query and/or downcode to an E/M?
 

ellzeycoding

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No, those codes should be held to the same standard.

Here are some good guidelines from another carrier's LCD...

https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/28572_20/l28572_gsurg051_cbg_010111.pdf

"3. Documentation of the progress of the wound’s response to treatment must be made for each service billed. At a minimum this must include current wound size, wound depth, presence and extent of or absence of obvious signs of infection, presence and extent of or absence of necrotic, devitalized or non-viable tissue, or other material in the wound that is expected to inhibit healing or promote adjacent tissue breakdown.

4. When debridements are performed, the debridement procedure notes must document tissue removal (i.e. skin, full or partial thickness; subcutaneous tissue; muscle; and/or bone), the method used to debride (i.e., hydrostatic versus sharp versus abrasion methods), and the character of the wound (including dimensions, description of necrotic material present, description of tissue removed, degree of epithelialization, etc.) before and after debridement."
 
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