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ulcer debridement coding

  1. #1
    Default ulcer debridement coding
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    I'm hoping someone can clarify ulcer debridement coding. The physician debrided an ulcer on the rt leg which was 3cm x 4cm (subcutaneous) and a large one on the left leg 12 cm x 7cm (subcutaneous). He is insisting we should bill 11042 x 2 with a 59 on the second procedure? In this situation shouldn't we be using the 11042 & the add on code 11045 based on cm's? (even though different legs). Also it is my understanding that an unna boot would be inclusive to the debridement but the physician feels we should be billing 29580 with a 59? Looking for some advise?

  2. #2
    Location
    Grand Rapids, MI
    Posts
    230
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    I agree with using the add on code of 11045, I don't think any payers would even accept a 11042 with a quantity of 2. Debridement codes are all according to depth now so the diffrent legs wouldn't matter as long as they were the same depth.

  3. #3
    Location
    Springfield, MO
    Posts
    17
    Default
    11042 the first 20 sq cm. 11045 for each additional sq 20 cm. 3 x 4 = 12; 12 x 7 is 84. Same depth so, 12 + 84 = 96.

    On MCR website, 29580 a modifier is allowed with 11042

    11042 x 1; 11045 x 4; 29580-59

  4. #4
    Default
    Thank you for your response! The only other question I have is what would warrent the 59 modifier appled to the unna boot? He is applying but what would make it significant enough to warrent separate payment?

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