Keys To Ensuring Optimal Wound Debridement

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What You Should Know About Debridement Coding Changes

Wound debridement codes have changed “dramatically” this year, according to Dr. Suzuki.
He notes the CPT codes for partial and full-thickness skin debridement (11040 and 11041) have been eliminated and the clinicians are instructed to report “by depth of tissue that is removed and by surface area of the wound,” according to the 2011 (CPT) Current Procedural Terminology book.4 As Dr. Suzuki explains, the clinicians are able to bill for the debridement of larger wounds (surface area over 20 cm2) by reporting the additional CPT codes, 11045 (subcutaneous over 20 cm2), 11046 (muscle and tendon over 20 cm2), and 11047 (bone over 20 cm2) respectively, in addition to 11042 to 11044.

Moreover, Dr. Suzuki says the 2011 CPT book suggests that one add up the surface area debrided per day. Then clinicians can report the CPT codes corresponding with the depth and the total surface area in 20 cm2 increments by appending with -59 modifiers if the wounds are on multiple body parts, according to Dr. Suzuki.

For example, if a patient has a large venous leg ulcer of 25 cm2 and you perform subcutaneous debridement, Dr. Suzuki says to report this as CPT codes 11042 (first 20 cm2) + 11045 (additional 20 cm2). If the wound area surfaces are 48 cm2, it would be 11042 (first 20 cm2) + 11045 (additional 20 cm2 x 2).

The most common misconception of the CPT codes for wound debridement, according to Dr. Suzuki, is that physicians should pick the CPT codes “using the deepest level of tissue removed.” This means that even if you see an exposed bone in the wound you are debriding, you should only report “subcutaneous debridement (CPT 11042)” if the tissue removed consists of subcutaneous tissue only.

As for the replacement of the “deleted” CPT codes 11040 and 11041, Dr. Suzuki notes the 2011 CPT book suggests using CPT codes 97597 (for the first 20 cm2) and 97598 (additional 20 cm2) for debridement of skin (epidermis and dermis only) and for “active wound care management.” He also suggests using an appropriate “E&M (evaluation and management)” code so you can include your skin debridement procedure provided within the physical exam and the medical management of the patient.

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Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

   Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo, Japan.

References
1. Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database Syst Rev. 2010 Jan 20;1:CD003556.
2. Steed DL, Donohoe D, Webster MW, Lindsley L. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg. 1996; 183(1):61-4.
3. Cardinal M, Eisenbud DE, Armstrong DG, et al. Serial surgical debridement: a retrospective study on clinical outcomes in chronic lower extremity wounds. Wound Rep Reg. 2009; 17(3):306-11.
4. Abraham M, Ahlman JT, Boudreau AJ, Connelly JL. 2011 (CPT) Current Procedural Terminology. American Medical Association, Chicago, 2011.

   For further reading, see “Current Concepts In Wound Debridement” in the July 2009 issue of Podiatry Today or “Assessing Debridement Options For Diabetic Wounds” in the March 2007 issue.

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